NYT: Are We Going to Let John Die?

[FourScore]

Are We Going to Let John Die?
By NICHOLAS D. KRISTOF
Published: November 28, 2009

If Joe Lieberman or other senators came across John Brodniak writhing in pain on the sidewalk, they presumably would jump to help him and rush him to a hospital.

Unfortunately, an emergency room won’t help — indeed, the closest E.R. has told him not to come back, he says. So, for those members of Congress who are wavering on health reform, listen to John’s story.

John is a sawmill worker from Yamhill County, Ore., where I grew up. He was a foreman at a mill, he felt strong and healthy, and he had very basic insurance coverage through his job. On April 18, he was married, at age 23, and life was looking up.

Ten days after the wedding, he was walking in his backyard carrying a neighbor’s dog — and he suddenly blacked out. That led, after rounds of CAT scans, M.R.I.’s and other tests, to the discovery that the left parietal lobe of his brain has a cavernous hemangioma. That’s an abnormal growth of blood vessels, and in John’s case it is chronically leaking blood into his brain.

John began to have trouble walking and would sometimes collapse. He developed spasms and restless leg syndrome, he began to use a cane, and his mind suffered.

“He forgets stuff a lot, he bumps into things,” said his new wife, Esther Brodniak. “But he keeps things light. He jokes about it.”

Perhaps the worst is the pain — blinding, incapacitating headaches that have left him able to sleep only in short intervals. He vomits daily when the pain surges.

“The pain is constant,” John said. “It’s a 7 or 8 on a scale of 10, and then it hits the high peaks and makes me vomit.”

With John unable to work, he lost his job — and his insurance coverage. Esther had insurance for herself and for her two children (from a previous marriage) through her job building manufactured homes. But she couldn’t add John to her plan because of his pre-existing condition.

Without insurance, John has been unable to get surgery or even help managing the pain. When he collapses or suffers particularly excruciating headaches, Esther rushes him to the emergency room of one hospital or another, but an E.R. can’t do much for him. One hospital has told them not to come back unless he gets insurance, they say.

Esther used up her family leave time to look after her new husband. “Then I went back to work, and he fell several times,” she said. “I told my boss that I had to quit. Taking care of John was more important than building someone else’s house.”

That meant that the couple had no income — and no insurance for anyone in the family, including the children. Neighbors have helped, and a community program has paid the rent so that they are not homeless. But bills are piling up, and John and Esther don’t know how they will cope.

The doctors warn that pressure from the growth could lead a major blood vessel nearby to burst, killing him. “They tell me I’m a time bomb,” John said. With a touch of bitterness, he adds, “It sort of feels as if they’re playing for time to see if it bursts, to save them from doing anything.”

I’m not a physician, and I certainly can’t speak to the medical issues here. But I have examined John’s medical records, and they appear to confirm his story.

John says the principal obstacle to treatment appears to be simply his lack of insurance. In August, he qualified for an Oregon Medicaid program, but he hasn’t been able to find a doctor who will accept him as a patient for surgery, apparently because the reimbursements are so low. Doctors tell him that his condition is operable — but that they can’t accept him without conventional insurance. He is increasingly frustrated as he watches his family crushed by the burden of his illness.

“The mill won’t let me go back to work until a doctor gives me a note saying I can go back,” he said. “I tried with several doctors. I said, ‘Just give me a note. ... I’ve got to do something for my family. But they won’t.” John and Esther agreed to tell me their story in hopes that somehow it would lead to medical help.

John’s story is not so unusual. A Harvard study, to be published next month in the American Journal of Public Health, suggests that almost 45,000 Americans die prematurely each year as a consequence of not having insurance. John may become one of them.

If a senator strolled indifferently by as John retched in pain, we would think that person pitiless. But isn’t it just as monstrous for politicians to avert their eyes, make excuses and deny coverage to innumerable Americans just like John?

http://www.nytimes.com/2009/11/29/opinion/29kristof.html?_r=1

[BrklynLiberal]

1. There just are no words......

:cry:

[malaise]

41. +1

:cry:

[Joe Bacon]

2. LIEberman could care less.

LIEberman ain't lifting a finger to help people like John. And his Republican pal Coburn would say that the neighbors and churches should help John if they feel like it

May LIEberman and Coburn burn in hell for what they are doing to John and all those others without insurance.

[Firstzar]

21. Amen!

Benedict Joe and Coburn have already got theirs. Let's hope that, if the Judeo-Christian view of the universe is anywhere near correct, they shall get theirs!

[leftstreet]

3. 45,000 Americans don't die each year from a lack of insurance

They die because our healthcare system is based on profits.

Single payer = no need for insurance

[dflprincess]

4. I'd like to know how many who have insurance die

because their out of pockets were so high they still couldn't get to the doctor in time.

I'd bet we could add several thousand to the number of people the current "system" kills. What do we need a middle man for anyway?

[leftstreet]

5. Good point

I'm so tired of these insurance shilling articles.

OMG we need INSURANCE!!!!1111

[JDPriestly]

13. You make a good point.

The House proposal allows for something like $5,000 per family co-pays or out-of-pocket pays or something like that I think. That would not help a couple like the one described in the OP where the spouse who otherwise would work cannot work for some reason such as to tend to the disabled spouse.

Single payer coverage that takes care of all but a very small co-pay is the only answer. Will it cost a lot of money? No more than the wars we wage. I wonder how much we spend to keep troops in Germany. Does keeping troops in Germany pay for itself. Sure, we need some troops there. But so many? I think we have maybe something like 65,000 troops in Germany. I wonder how much each person costs us? Could we do with fewer without damaging our security?

[dflprincess]

40. The House bill allows annual out of pockets of $5,000 for a single and

$10,000 for a family. Plus whatever they pay for premiums and plus anything not covered by their policy (incidentals like vision and dental). Like the premiums, those out of pocket (cutely called "cost sharing" in the bill) may go up every year.

Really, all we're getting with these bills is the same system we have now. We'll be paying for "coverage" with no guarantee of being able to get care.

[left is right]

19. this is a crucial point

too many Americans do not receive the necessary care because they 1 do not have insurance and 2 those that do can't afford the out of pocket expense. We do not need health insurance we need healthcare

[laylah]

32. My doctor "fired" me

because I couldn't afford the co-pay. He was paid 80 - 90% for everything but the bastards wanted 100% and I couldn't do it. I have avoided the doc for much too long because I cannot afford the out of pocket. Now I have "issues" and have NO idea what to do.

[debbierlus]

47. Or, they have insurance and they refuse to pay

[Liberty Belle]

50. I know of at least two.

One had the best insurance one could get, supposedly. She was a nurse who later worked for a major insurance company. but after she retired and got cancer, her insurance wouldn't pay for chemo after the cheapest drug caused her to have a life-threatening reaction. There was an expensive drug her doctor thought could work, but she never got to try it.

Another friend was covered by the VA. For years they dismissed her health complaints as various chronic conditions but never ran any scans. By the time she finally collapsed and they had to run them, she had stage 4 cancer and was dead 2 weeks later.

[UndertheOcean]

6. The Doctors who refuse to treat him due to lack of insurance are partly to blame here

and those who refused his medicaid .


Tragic , and nobody seems to blame the greedy selfish prick doctors in such cases. Refusing Medicaid or Medicare should be made illegal.

:mad:

[Cirque du So-What]

7. How, exactly, would such a law be constitutional?

Requiring doctors to perform medical services that may end up costing them money? We aren't living in a totalitarian regime yet! You can call them names, but they are under no legal obligation to accept less than what they ask for their services.

Should-hood is shit-hood. Spending time complaining about the way things *should* be is about the most useless thing a human being can do - especially when the answers one comes up with cannot be implemented anyway. FAP FAP FAP

[sandnsea]

23. Non-profits in Oregon are required

We also have health delivery systems so doctors can't set up practice anywhere they want either. If you want to be the health clinic provider for a city, you have to accept medicaid and medicare and non-profits have to see any patient that comes to the clinic. There are already all kinds of laws regarding the delivery of medical services to try to make sure service is provided without competition that could put hospitals and clinics out of business.

[Lyric]

30. Wrong.

The government has power over commerce, as explicitly noted in the Constitution, and as such has the right to set the regulations that it chooses. Physicians get their license to practice from the government. Making the acceptance of government insurance a requirement for obtaining a license to practice seems perfectly fair to me. Alternatively, the government could go about it differently and say that all doctors who accept private insurance are not allowed to discriminate against government insurance. If We The People don't like it, then our recourse is to vote for politicians to change the law. But frankly, if such a regulation were ever actually passed, I think seniors would be too happy with the results to want to change it.

[CubicleGuy]

35. The government has power over commerce?

"Section 8.

"The Congress shall have Power...

"... To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes..."

Of course, the exact meaning of this has been a source of controversy almost since the Constitution was written. It's one of the reasons why the Feds believe they have every right to interfere in state decisions to legalize the use of marijuana.

[Lyric]

37. I'm not sure what your point is.

If you think the Feds are misusing their power to regulate commerce in regard to marijuana, then convince enough other people that you're right and get them to vote for pro-pot politicians, or find a way to gain standing for a court case. None of that is relevant to the fact that physicians' offices are businesses, and as such, Congress has the power to set the rules they must abide by. Your point about marijuana doesn't negate the fact that, contrary to the assertion in the post I was replying to, new federal regulations that eliminate discrimination against Medicare and Medicaid would NOT be unconstitutional.

:shrug:

[Ms. Toad]

42. The governmnet has the power over INTERSTATE

commerce - not general commerce - and much of insurance is intra-state regulated. Medical licenses are state based - that doesn't give the federal government the right to impose licensing preconditions.

That clause has been stretched pretty thin in recent years, and the Supreme Court has found unconstitutional some recent attempts by Congress to stretch the reach of this provision.

There may be some valid commerce clause based regulation - but is not as simple as you suggest.

There are also other justifications for federal regulation - all of the speed limit laws and DUEs in the past, for example, have been based on quid pro quo. You want federal highway money - you enact a lower speed limit (or BAC level for DUIs).

[Cleita]

9. This is the problem with a tiered system of medical benefits.

The poor people who get put in the Medicaid program get benefits and reimbursements to doctors cut over and over again to the point that doctors can't accept them anymore. This is why only single payer really works for everybody but no one who can do anything about this will. I have worked for doctors on and off all my life and all doctors will accept patients who can't pay, but there is a limit as to how many. I hope he finds a doctor who can bring him in a pro bono way.

[AlbertCat]

53. greedy selfish prick doctors

Yes....it's your doctor's fault. :eyes:


Then go to a shaman and shut the fuck up....

[Cleita]

8. Send the medical bills to Congress. I don't know any other way of getting their

attention. Our country is in the hands right now of those who seem to have no compassion whatsoever.

[tblue]

10. This is 'pulling the plug.'. Lieberman is standing between this man and his Dr.

This is so unconscionable I could scream.

[RagAss]

11. May they burn in hell for turning their backs on folks like John.

[diane in sf]

12. His family should check out Mexico or India for the surgery and try getting an appeal

for money for the surgery. I would try to do something similar. What's happened to him is a crime, one of many in our disgusting system of nonhealth delivery.

[WillowTree]

14. Too bad his wife quit her job.

If she hadn't, she would have been able to add him to her coverage at least at the next open enrollment period. By law they would have been required to accept him without regard to pre-existing conditions at open enrollment, the only exception being if her employer's plan did not allow any spouses to be covered. It's not the optimal situation and she may have had to get an attorney to force the issue, but at least they would have been better off than they are now.

[bobbolink]

45. I knew somebody would speak up with a judgment.

How DARE you presume to project YOUR indictment onto people who are hurting like this!

[laughingliberal]

54. Might have been something but they can, generally, deny coverage for pre existing conditions for

12 months after start of coverage.

[sandnsea]

15. They need to find a non-profit

Non-profits have to accept Medicaid in Oregon.

It's too bad our subsidized insurance isn't fully funded because he'd have been fixed up a long time ago.

[Jenny_92808]

16. Lieberman would probably step over him and suggest

he should have a bake sale as he walks away.

[Greyhound]

17. Already suggested on this thread.

Begging is the New Amerikan Way.

"C'mon boy, give us a little sof-shoe and we might drop a penny in yur hat".

[regnaD kciN]

18. But it's all very simple...

You see, all we need to do is get rid of that pesky public option and replace it with something like triggered co-ops, and Lieberman and the others would jump on board in record time, and, soon, John would be able to (and, in fact, would be required to) buy any private insurance he could afford. Problem solved!

:sarcasm:

[sandnsea]

22. John would get coverage for $55

And be able to see a doctor just like anybody else with insurance. Oregon also has a pool for people with pre-existing conditions, although it's horrifyingly expense but it also has subsidies. If it were fully funded, say with increased federal funding, John would have been well and back to work eons ago.

[HamdenRice]

20. But, but, but ... If I can't have SINGLE PAYER NOW, then let him DIE!!!11! It's WORTH IT!1!

:sarcasm:

And if you think that's an exaggeration, you didn't real the previously existing condition thread a few weeks ago:

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8747753&mesg_id=8748092

[Sebastian Doyle]

28. The insurance companies greed is the problem

Removing them entirely from the equation is the obvious solution. Further enabling them with 40 million mandated customers is not.

[dsc]

33. actually the bill won't help him at all

Neither one is working right now. They have no money to pay for insurence, condition or not.

[laughingliberal]

55. Correct. He would still just qualify for Medicaid. Would not have the money to purchase private

insurance even with a subsidy.

[mike_c]

24. this is where our national worship of greed has brought us....

Put simply, John is a crappy consumer-- the worst kind, a consumer with needs, but little future. No one will make a profit on John. To the contrary, John will cost lots of money and reduce profits for everyone who helps him. John must die, for the benefit of share holders everywhere.

[MadMaddie]

25. This is the reason why if an employee loses a job

that they should be able to carry over their insurance at reasonable rates or go into a pool where they can have coverage.

How many people will we see die while Lieberwhore whores around for the Insurance companies.

This poor guy and his family are just another story amongst the thousands of Americans suffering, they play by the rules and they suffer.

[alfredo]

26. Senator Tim Johnson had the same thing.

[Vinca]

27. What a heartbreaking story. Putting our lousy health care system aside

and ignoring the senators without conscience like Holy Joe, you'd think a hospital or doctor would step up to the plate and do what's right. Maybe one will after this article. Sometimes I really hate this country.

[SmileyRose]

29. It isn't a lack of insurance

it's a lack of affordable access to medical care.

The doctors want promise of payment up front. This was not always so. I do not begrudge the doctors a damn fine living - but I miss the days when one could obtain LIFESAVING medical care and then spend the next 10 years making payments.

[KansasVoter]

31. And the GOP is pro-life. What a joke!

[Earth_First]

34. HEY CONGRESS: ARE YOU LISTENING!?!

Aside from my otherwise current decent health; I am no different than John.

I am one accident or unfortunate lurking medical condition away from a disastrous situation.

Here's the kicker; are you listening, Mr. Lieberman: My two hands and I are what drives this country. I often work 6 days a week, often in the 55-65 hours a week of back-breaking, blue-collar labor. The members of the GOP and their democratic ilk have this disgusting fantasy that the average American is fat, ignorant and lazy. I go to work, I pay my taxes and I raise my family, barely above the water due ENTIRELY to what you and your friends have created out of the health care industry. I GUARANTEE you that if I find myself under such an unfortunate set of circumstances as our friend John; I will whither away on Hospice on the sidewalk in front of the Capital Building so you and your cronies will have to witness what you have created of our country first hand on a daily basis.

Christ almighty, now I'm all fuckin' worked up

:mad:

[AlbertCat]

57. HEY CONGRESS: ARE YOU LISTENING!?!

No.

They're in DC...where no sound from the outside penetrates unless it's on the MSM. That's why they think teabaggers and the like are some kind of force in this country instead of a tiny fruitcake minority who have nothing to offer.

[dorktv]

36. No link to a website where we can at least make a donation as a stop gap?

While we nag Congress into doing the right thing?

[prairierose]

38. I don't think Congress will do the right thing...

no matter how much we nag. Too many of them are corporatists...bought and paid for. My congresscritter is a bluedog.

[Honeycombe8]

39. Since they have no income, and they have children, they qualify for Medicaid, don't they?

I guess it depends on the state, as to the particular rules, but Medicaid is a combination of federal and state funds to pay for medical care for people at or below the poverty line (the income level may vary with the state, I guess).

So he can now get complete medical care, since they now have no income. It will be 100% free.

Medicaid doesn't pay for all (or any?) prescriptions, though. However, some companies directly subsidize their name brand medications for poor people (you sign up on their websites or something).

They also qualify for food stamps. And the children also qualify for medical care under the SCHIPS program.

[TheMadMonk]

46. Not necessarily. She Q.U.I.T. her job.

Don't know how that works for eligibility requirements there, but in some places voluntarily leaving employment can disquailfy people from government assitance for a considerable period of time.

[laughingliberal]

56. He has Medicaid. The doctors don't accept it because the reimbursements are too low nt

[slipslidingaway]

43. An unfortunate example that coverage does not equal care when providers...

will not accept the insurance, in this case Medicaid.

:(

"...John says the principal obstacle to treatment appears to be simply his lack of insurance. In August, he qualified for an Oregon Medicaid program, but he hasn’t been able to find a doctor who will accept him as a patient for surgery, apparently because the reimbursements are so low. Doctors tell him that his condition is operable — but that they can’t accept him without conventional insurance. He is increasingly frustrated as he watches his family crushed by the burden of his illness..."


http://pnhp.org/blog/2009/11/02/expanding-medicaid-to-save-money/

Expanding Medicaid to save money

"...

* As a welfare program, representing a population without an audible political voice, Medicaid is chronically underfunded.

* Inadequate reimbursement rates due to inadequate funds results in a lack of willing providers. Too many physicians are not willing to accept the losses under this program. This lack of providers impairs access to care.

* Many states are struggling with budgets burdened by massive Medicaid spending. Although this expansion would use federal funds initially, some of the financing burden would be shifted to the states even though they do not have the budget flexibility of the federal government.

On paper, Medicaid looks like a great program. It provides a generous benefit package for lower-income individuals who cannot afford to purchase private health plans. In reality, most Medicaid patients do not have the same access to essential specialized services that wealthier privately insured individuals do, and access to even basic services is often compromised.

Expanding the Medicaid program further locks in a tiered health care system, effectively providing less for the least amongst us. In health care, that’s simply not acceptable."

[bobbolink]

44. Goddess, some days I HATE THIS COUNTRY!

FUCK ALL THE GREEDY BASTARDS TO HELL!!!

[dugaresa]

48. I read this and I am disgusted by the insurance situation and the doctors that would let him suffer

because their reimbursement for the procedure is too low under Medicaid.

What kind of doctor refuses to help someone so much in need of assistance. What does it say about their level of humanity?

[Liberty Belle]

49. John's heirs should sue the government for the low Medicaid reimbursement rates

and sue the damn doctor just for good measure.

We DO need higher Medicaid rates, and one of my biggest concerns with the healthcare bill is that it doesn't too enough to address this problem. John's problem is all too common. A friend of mine has a similar chronic and painful condition and Medicaid won't cover anything except ER visits - and the ER just sends him home, too and tell him to go see a specialist that he can't afford. He is going blind without help. His wife just died of cancer because the damn insurance company she had -- supposedly one of the best -- wouldn't pay for a more expensive chemo treatment after she had a bad reaction to the cheapest drug.

Our system is worse than third world countries, period.

[unabelladonna]

51. f the doctors

and take away the free healthcare from congress.

[Iwillnevergiveup]

52. Nicholas Kristof

is a highly respected journalist and true shining light at the NYT. I'll be looking for offers of help to pour in, and hope he does a follow-up.

K&R