Health Care, Boston and the Luck of the Draw

Submitted by: Mike Spindell, guest blogger

Asklepios.3I must begin this guest blog with a bit of a confession. When I first started posting on Jonathan’s blog many years ago I found that he had recognized me in one of his end of the year posts. He wrote words to the effect that what he found appealing in my comments was my tendency to reveal much about myself in the course of them. He had seen into the essence of not only my writing style, but also of the way I interpret the world around me. For me it always starts from my personal emotions about an issue and then I work to try to see how my personal experiences can apply to the world around me. It is the key to my empathy, which allows extrapolating my personal experience into a more global view of the world I live in. I imagine that is how it is for most people, but we all live in the isolation of our own consciousness. It is in truth not the best writing style and certainly not the most creative one, but at least limited by my own ability to be self critical, it is the most honest writing that I am capable of producing.

With that caveat in mind, let’s talk about my own health care experiences. I was genetically endowed with the predisposition towards heart disease. Both my parents and many of their siblings died in their early fifties from variations of heart disease. My Mother had perhaps four heart attacks (MI’s) and three strokes. My father had two heart attacks. As a family we were far from wealthy, struggling to maintain ourselves at the lower end of the middle-class, but my father had prescience that kept us from disaster. He always paid for good medical coverage and back then and most importantly medical coverage was affordable. Given my seeing so many medical issues as a boy my families medical insurance made a big impression on me. As a civil servant in New York City in lieu of an adequate salary I was covered by good health insurance and always elected to have the best, most costly plan. Up until the age of 36 this “Cadillac” (to use the current verbiage) plan wasn’t necessary because I seemed to be in good health, although the high blood pressure that kept me out of the Viet Nam draft was a concern to Doctors, but then I rarely needed to see Doctors. Six months after I married though at age 37, I suffered my first massive heart attack. With the help of my wife who nursed me through the recovery I seemed to return to normal. The hospital costs were huge and would have bankrupted me but for my health insurance. As my life progressed I had two more MI’s and then finally Congestive Heart Failure so bad that it led to me being put on an artificial heart device LVAD to keep me alive and finally a heart transplant to give me a new life.

Thanks to my Medicare and my secondary health insurance I am alive today and nearing 70 years. My health insurance has probably paid out many millions to keep me alive and I sm grateful for that and in truth very lucky that I chose to be an underpaid Civil Servant.

My personal experience with the health care system came to mind when the Boston Marathon bombing occurred leaving so many victims with dire health care problems, many with loss of limbs. I can remember that day thinking what the costs of these patients treatment would be and how many of them would pay for it, even with the Massachusetts Health Insurance system. You see even though my Heart Transplant was covered, it is estimated that costs to the transplant patient are $30,000 for the first year after the transplant. I can’t cry poverty, but let’s say that those ancillary costs wiped out most of my savings. The loss of a limb and the rehabilitation from it can take many years and is costly. Prosthetics wear out and must be replaced. Depending on ones occupation their income can be adversely affected and their family lives severely disrupted as a consequence. While it is true that thus far some $23 million dollars has been raised purportedly for the victims how far will that money go towards allowing them to return to their normal lives? Given this what are the implications of the response to this particular act of horror in terms of the entire health care debate that is far from settled in this country?

“The price of a new prosthetic leg can cost anywhere from $5,000 to $50,000. But even the most expensive prosthetic limbs are built to withstand only three to five years of wear and tear, meaning they will need to be replaced over the course of a lifetime, and they’re not a one-time cost.

Ten days after the Boston Marathon bombing, the most gravely injured among the victims have begun the daunting road to recovery. At least 14 of those injured in the blasts had to have limbs amputated, and at least two people had multiple amputations.

Each prosthetic limb must be custom fit to every patient, and costs can add up. Once they’re fitted with the prosthesis, patients also need to attend physical therapy for weeks or months.

“Depending on what components you get on it, [the cost] can vary greatly,” said Glenn Garrison, director of prosthetics and orthotics at the Hospital for Special Surgery in New York. “They’re probably in line with a cost of a car. It can be a pricey thing to work with.”

With physical therapy, Garrison said amputees could start walking on their own within two to four weeks after receiving a prosthesis. According to Garrison, most patients will have one prosthesis for the first year, but will likely need a second one to accommodate their changing physique. After that, a prosthesis usually wears out every three to five years.”

One minute a person finds themselves excited, on a beautiful day watching runners finish the oldest marathon in the country, partaking in a long community tradition and then the explosion, pain, blood and terror at what happens to them. Help arrives, treatment begins and for many a lapse into the peaceful bliss of unconsciousness. Hour later they begin to awake in pain and to discover what they have lost. Gradually the realization hits that it will take years to get their lives back together and in fact nothing in that life will ever be quite the same again. Meanwhile they, if lucky, are with the comfort of loved ones and friends and well cared for by the hospital staff. They are somewhat celebrities and there is great public interest in them and their plight. Money for their care has flowed in from an aroused and concerned public and the least of their worries is how much will this cost and what effect it will have on their ability to earn money. Then as with much of what is current in the media’s reportage of the “news” their individual plight falls to the background of the public’s consciousness. The donations dry up and with that the funds coming in and they are faced with an enormity of debt, pain and rebuilding their lives.

“Cost of amputating a leg? At least $20,000. Cost of an artificial leg? More than $50,000 for the most high-tech models. Cost of an amputee’s rehab? Often tens of thousands of dollars more. These are just a fraction of the medical expenses victims of the Boston Marathon bombing will face.

The mammoth price tag is probably not what patients are focusing on as they begin the long healing process. But friends and strangers are already setting up fundraisers and online crowd-funding sites, and a huge Boston city fund has already collected more than $23 million in individual and corporate donations.

No one knows yet if those donations — plus health insurance, hospital charity funds and other sources — will be enough to cover the bills. Few will even hazard a guess as to what the total medical bill will be for a tragedy that killed three people and wounded more than 270. At least 15 people lost limbs, and other wounds include head injuries and tissue torn apart by shrapnel.

Health insurance, as practically anyone who has ever gotten hurt or sick knows, does not always cover all costs. In the case of artificial limbs, for example, some insurance companies pay for a basic model but not a computerized one with sophisticated, lifelike joints.

Rose Bissonnette, founder of the New England Amputee Association, said that the moment she heard about the bombings, she knew immediately that her organization’s services would be needed. The advocacy group helps amputees navigate things such as insurance coverage for artificial limbs. Bissonnette shared one group member’s struggle to get coverage for artificial arms as an example of the red tape some bombing victims could face. The woman “got a call from the insurance company and the person on the other end said, ‘How long are you going to need the prosthetic hands?’” Bissonnette recalled.”

Although it is not certain, I would guess that providing the Boston victims with some financial security is a distinct possibility, since it would appear a bi-partisan gesture. Yet can we really be sure that this will be the case. We know already that many of our veterans lack the basic care their service to this country has entitled them to and we know that in the Ryan budget proposal for instance, there are severe cuts in veteran’s care. We also know that many of the victim’s families from 9/11 feel they have been shortchanged and promises broken. The vast majority of Americans, if polled would believe that the bombing victims and the veterans should be taken care of, but no one can say if this feeling will be transformed into governmental action. Then too, the same week that the bombing occurred there was yet another tragic series of explosions in Texas. Even though the devastation was greater than Boston and the explosions weren’t intentional, how much real aid will be given to the victims in Texas and to the town that was devastate by the explosions? Certainly there will be lawsuits, but how long will it be before they are settled and while pain and devastated lives are immediate.

However, these are all issues that have made the radar of the news media. Every day in this country people are being devastated by health care problems, most of which are no fault of their own. This could be a car that was rear ended, the collapse of scaffolding or possibly a congenital condition such as my own. Those that oppose the concept of a national health care system always justify their opposition by mouthing the idea of “personal responsibility” and individual choice. To my mind and to my experience that is patent nonsense. We live in a time of a shrinking middle class, of wages that have not kept pace with the cost of living and with families scraping by from paycheck to paycheck. We also live in a time where the rate of poverty in this nation has increased rapidly as the years have gone by and where many people, even with g-ood jobs have to choose priorities and frankly if you are fairly healthy putting food on the table for your family, compared to paying health insurance premiums, is a no-brainer. In the United States today at least 55 million people are without health insurance. It is easy for those opposed to national healthcare to spout inanities such as Mitt Romney’s “they can go to the Emergency Rooms” and the harsh judgment of his that 47% of Americans are “takers” and thus don’t deserve to be given any aid.

The nature of the health care system in this country is a disgrace from my point of view. The “Health Industry” has become overtaken with the profit motive and this once great country (from the perspective of quality of health) has fallen far below that which most Americans would deem minor nations. I believe that quality health care should be a right and not just a privilege. The evidence to me is overwhelming that our Health Care System is broken and outdated when compared to other industrialized countries and that is but one reason most of our citizens are being reduced to Third World status.

“More than 40 percent of U.S. residents went without health insurance or had coverage that didn’t protect them against high medical costs last year, survey results released Friday reveal.

Thirty percent of people in the U.S., or 55 million, were uninsured for at least part of the year prior to the survey, which was conducted from April to August 2012 for the Commonwealth Fund, a New York-based research organization. Another 30 million people, or 16 percent of the population, were “underinsured,” meaning their health plans offered too little coverage and exposed them to high out-of-pocket costs, the survey found.”

The quote above and the following quotes/statistics below are taken from an excellent Huffington Post article titled: Health Insurance Market Left out 55 Million Americans in 2012” by Jeffrey Young.

This truly is the “luck of the draw” as my own life has proven. The needed health care a person gets is very much dependent on the circumstances into which they were born and the circumstances of the arc of their life. Mitt Romney was born into a circumstance that guarantees him a full life of excellent health care. This is true of Paul Ryan and Donald Trump. By the same token so were Michelle and Barack Obama and Harry Reid. Yet many obviously believe that this is the way things should be. Luck of the draw should to their mind determine everyone’s lives, though in truth most who believe that already have hit the jackpot.

“People earning up to four times the federal poverty level, which is $11,490 for an individual this year, were the most likely to be uninsured or underinsured. The lower the income, the more common uninsurance or underinsurance was, according to the survey.

“President Barack Obama’s health care law offers financial assistance for health insurance to low- and middle-income people earning up to 400 percent of the federal poverty level, which is $45,960 this year for a single person.

Sara Collins, the vice president for affordable health insurance at the Commonwealth Foundation, said Obamacare could mitigate some of the consequences of an expensive health care market.

“Of the 55 million adults in the survey who were uninsured during the year in 2012, more than half have incomes that would make them eligible for coverage under the law’s Medicaid expansion if they are legal residents,” she said during a conference call with reporters Thursday. “And more than one-third have incomes that would make them eligible for subsidized private plans sold through insurance marketplaces.”

The impact of the health care law’s Medicaid expansion will be blunted, however, by Republican governors and Republican-led state legislatures that are refusing to broaden the joint federal-state program to more poor people.

And while subsidies for private insurance, in the form of tax credits, will be available, they may not be large enough to offset premium hikes for some people, which health insurance companies say are partially the result of Obamcare’s benefit guarantees.”

I understand that many believe that those in poverty were destined to be there because of their lack of skill, but to me this is nonsense. Poverty, breeds poverty as many, many studies through the years have proven. The few who escape poverty do so perhaps because of their innate skills, but I believe that too represents “Luck of the Draw”. Germane too to this discussion is the fact that even if you are one of the lucky ones to receive health care coverage in this country, the system itself is not really effective and also needs fixing.

The figures disclosed by the Huff Post article linked show that the United States spends the most per capita on Health Insurance of any industrialized nation. We are at more than 17% of GDP and the next 9 countries that spend the most are around 10 to 12% of GDP, and most of those countries provide government subsidized health care. Yet the United States is 27th worldwide in life expectancy. Think about that this country that so many think is exceptional has the 27th best life expectancy rate in the world, yet spends the most on health care. Why is that? My conclusion is that the difference in expenditure is directly related to rapacious profit and it exists throughout the industry. Our huge hospital conglomerates, our drug companies and especially our health care insurance companies are gouging us for every penny of profit possible, while at the same time providing us with a lesser degree of care. For the Health Insurance companies it is the fact that their cost of providing services run at about 15 to 17%, whereas Medicare and Medicaid are about 3%. That 3% figure reflect the administrative costs in other countries and shows one reason why they spend less of GDP on health care.

The drug companies too gouge us and even Medicare and Medicaid are not allowed to negotiate with them to lower prices. An example of this gouging comes from the antacid medications Nexium and Prilosec. When the patent for Nexium ran out, its manufacturer added some non-palliative solutions to their formula and claimed it was a different drug without proof to back up the effectiveness of the new formulations. Nexium is a costly prescription drug even with a good prescription plan like mine. Non-prescript Prilosec has been shown in tests to be every bit as effective as Prilosec, since they are essentially the same. What happens too I imagine with Nexium, is that via detail people, Physicians are given bonuses of one sort or another for prescribing Nexium. This is of course merely a supposition on my part, but many have pointed out in other instances that this is a typical practice of the drug industry, with the compliance of Doctors who like “free things” after all “what’s the harm” except for off the charts healthcare costs.

Having spent much time in hospitals and seeing the bills paid by insurance it is easy to see that our private hospital consortiums are vastly overcharging for the medications and the services they give to patients. Many claim it is because of the care they must provide to the indigent, but the growth and centralization of the hospital industry belies that. Clearly there is much profit to be made.

This brings me back to the nub of my argument which is that the U.S. should be providing cheap health care to its citizens as a matter of course. This of course will be derided by some here as being socialistic, but tome that argument is nonsensical on at least two grounds. The first being of course that the Constitution is neutral on Socialism and indeed on Capitalism too. The issue is providing for the welfare of the people and in that sense the idea that this always could be done better by private industry is merely a propagandist ruse meant to fool the public. Indeed the first Social Security System in the world was introduced by the uber Right-Wing Otto Von Bismarck in Germany in the 1870’s. He was hardly a socialist, but he understood that providing for the welfare of the people is a proper role for government. In my opinion, once again, good health care should be considered to be a basic service that every citizen should receive.

As those maimed and killed found out as they joyfully watched the conclusion of the Boston Marathon, life and limb are dependent on the luck of the draw. This is true every second of every day that we live.

Death and dismemberment cannot be ended by government decree, but the effect of those “luck of the draw” incidents can and should be mitigated by the Government of all the people. That’s my opinion as one of the “lucky ones”, what’s yours?

Submitted by: Mike Spindell, guest blogger

54 thoughts on “Health Care, Boston and the Luck of the Draw

  1. Dredd, LBJ stepping down had NOTHING to do w/ honor for chrissake. He was the consummate political animal and knew there was a landslide coming. Geez!

  2. bill mcwilliams,

    I don’t know if you can go as far as to call it a conspiracy, but there is something about to happen-on a massive scale (meaning: civil or international war)-in America:

    Since early this year, the Elites have signed into law the right for law enforcement (FEDs) to check your emails, internet accounts, phone records, etc.; issued a ‘decree’ that if we (American civilians) even think about stepping out of line, then the FEDs/Elites have to right to issue drone attacks;

    Boston Bombing, Texas Explosion (why would you bring an ATF swat team, after the ‘incident’ was declared an accident, even before a thorough investigation was conducted?), Ricin letters to President & Congressional leaders, North Korea “threat” (even though former NBA player/turned porn star Dennis Rodman was having dinner with the Korean Leader/President at the time of supposedly missile threats aimed at South Korea); Canadain Officals ‘thwart’ another bomb threat for the US-all of these events transpiring in less than 3 weeks combined?

    It doesn’t add up. Something is about happen. Something big………or maybe they (Elites) are trying to distract us from the only threat: Another Revolution on US soil.

    For some reason, every ‘terrorist act’ have been committed by individuals or groups of Islamic faith? We (US) seem to find a way to blame Muslims for the weapons that we sold to their countries’ leaders; then, we act surprised if they (countries’ leaders) use the same weapons against our soldiers (the same soldiers who were given orders to destroy & occupy Baghdad since 2003: the 2nd largest Muslim city-also, known as the Mecca City for Islamic culture & heritage)

  3. RWL claims, “It doesn’t add up. ”

    Maybe it’s your internal adding machine that does not function. This is much more likely outcome than your conspiracy “dabblings,” since you lack even the desire to label your own unsupported wanderings as “a theory.”

  4. Brilliant, Mr. Knauer. It’s obvious that you are extremely well informed, deeply insightful, and overflowing with the milk of human kindness.

  5. Bill McWilliams whines weakly, “…and overflowing with the milk of human kindness.”

    When you bring ugliness to a mirror, please do not pretend to be offended at the sight of ugliness.

    Your conspiracy “theories” are utterly without merit, and your dwelling on them does not make them any more true.

    “It doesn’t add up” is not evidence.

  6. Just put your head back in the sand – and continue taking your TEAvee’s advice, Mr. Knau Nothing.

  7. Thanks Mike, like so many stated well written and thought out. It does take the experience if being there to really “get it”
    When my trigeminal neuralgia started I had no idea my father had BC/BS insurance on me (I was 25, we had never talked about insurance. I had never had to deal with being billed for medical care, it went directly to him/through the insurance.)
    I could not work and had to go on assistance, which included medical assist. I could only afford to be seen by a clinic. The care was sometimes very good, when you had something difficult or strange, and an attending would be called in, and equally bad when yo had run of the mill problems.
    I found oit I had the private insurance months later and suddenly I was in private doctor’s offices, the care on a much better scale – even when compared with seeing an attending at the clinic.
    Medicare is a godsend for me, as is my bs/bc supplemental which Is draining my savings.
    Single payer seems to be the way to go.
    In the meantime how much money would be saved in Medciare (and soc. sec. too) if they really went after the fraud and also had bid contracts as opposed to the no bid that still favors company over beneficiaries.

    • “I found out I had the private insurance months later and suddenly I was in private doctor’s offices, the care on a much better scale – even when compared with seeing an attending at the clinic.

      Medicare is a godsend for me, as is my bs/bc supplemental which Is draining my savings.”


      You speak truly, because you and I with our different yet critical illnesses have both been there. There is a distinct difference in health care for the insured. As you also point out, since we both are/were in situations that were medically interesting the health care people took more of an interest and the care was better. My recent hospital stay gave me a luxe private room because as a post transplant person I am immuno-compromised and having Medicare and a good secondary I am well-insured. I appreciate my good fortune. Is it so wrong to believe that everyone’s health care should not be a matter of “luck of the draw?”.

  8. Mike, No it is right to believe it should not just be the luvck of the draw and the lucky (or seriously ill/interesting) Reminds me of the Chinese curse (just googled it, neither Chinese nor proverb or curse but what the heck) May youlive in interesting times. In the case of health care if you are poor you need to hope you live in an interesting body.

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