John Boyle

John Boyle is a friend who works as a writer at the Asheville Citizen-Times This is his column from April 8, 2012:

John Boyle experiencing the invention of a local man.

John Boyle

I just can’t imagine why we need to change a single thing about our health insurance system.

Are you crazy? Of course, the Supreme Court should throw out health reform in its entirety and let us rely on this wonderfully humane and efficient system that’s totally driven by patient-satisfying profit.

Sorry if I just busted the sarcasm meter.

I’m a little testy these days, what with a herniated disc in my neck and an insurance company, United Healthcare, that dragged its feet in approving the surgery my highly experienced surgeon recommended to relieve the constant pain and numbness.

Oh, and I did I mention I get to cover $6,000 or $7,000 in out-of-pocket costs, in addition to my premiums, while United Healthcare rakes in an annual profit of $5.1 billion and pays its CEO, Stephen Hemsley, $10.8 million annually?

As you read this, I’m recovering from surgery that repaired that herniated disc in my neck.

I’m grateful to have such skilled surgeons around as Dr. Eric Rhoton, and I have no problem with guys like him making a good living.

I’m not so enamored of United Healthcare, which dilly-dallied all week on “pre-certifying” the surgery. It was scheduled for Thursday morning, but we had to push that back to Friday.

What’s another day of pain, numbness and worry to them, though? They’ve got 5 billion reasons to be happy.

Here’s the kicker: I am one of the lucky Americans with a job and health insurance. I am grateful for this, trust me.

But I’m going to complain now — in what I hope is a constructive tone that illustrates why a for-profit health insurance industry is a nightmare for actual human beings.

I’ve paid about $3,600 a year in insurance for years now, which covers me and my two boys. The corporation I work for, Gannett, pays that much or more.

I’ve been here 17 years now, so I figure I’ve paid more than $50,000 in premiums and Gannett probably $60,000 or $70,000. I’ve had shoulder surgery, a colonoscopy and some other procedures that I’d estimate probably cost in the neighborhood of $35,000.

But I always have deductibles and the dreaded patient’s portion of the fees. So I’ve gotten some benefit from my insurance carriers (it used to be Blue Cross), but overall they’ve made a tidy little profit off me over the years.

For this neck surgery, I’ll have to pay the surgeon’s office more than $1,800 out of pocket and Mission Hospital $3,200. Physical therapy visits afterward cost me $60 each, out of pocket, while the co-pay to the surgeon’s office are $50 each.

The surgery alone is $13,000. The hospital is saying their charges will come in at about $16,000. Throw in some miscellaneous stuff and I’m sure it’ll hit $30,000 quickly.

When all is said and done, I’m estimating I’ll have to pay $7,000 out of pocket on $30,000 of care.

As I said, I’m lucky to have “good insurance.” A hundred years ago, I would’ve had to live with this pain and lost function in my arm. And if you have a major catastrophe in life, just imagine how high those medical bills would be without insurance.

But I don’t believe we have the best system in the world, primarily because it’s just wrong to tie insurance company’s massive profits to patients’ well-being, or more likely, their suffering.

In my case, United Healthcare denied an MRI that my family physician ordered and approved. So no MRI. My physician put me on physical therapy and meds, a combination that offered no relief. Then I started getting numbness and tingling down my right arm.

A good friend who is a nurse practitioner and had a disc problem in her neck that caused very similar symptoms to mine insisted I see a specialist — and get an MRI. She noted that you can get permanent nerve damage and loss of muscle function if you let such things go.

I mentioned that United Healthcare refused to let me get an MRI.

“You’ve got to have a picture to know what you’re looking at,” she said.

Once I got in with the Carolina Spine & Neurology, they got an MRI approved quickly. It showed a herniated disc, which means it’s bulging out, pushing into the nerve and causing all that pain, numbness and tingling.

 

The surgeon, who’s got 20 years’ experience, showed me the MRI. We talked a lot. I did the obligatory online research and talked to a lot of people.

It seemed very unlikely the disc would unherniate itself after three months of pain, and I was starting to lose some strength and function in my right hand. He recommended surgery to remove the offending disc and fuse the vertebrae above and below, which should relieve my pain and the numbness and restore me to a normal life.

It sounded pretty good, really, if that gives you any idea of the pain level.

We scheduled surgery for Thursday. United Healthcare, notified March 30 of this plan, did not precertify it, despite the diligent efforts of a Carolina Spine employee and a rather feisty call from my wife.

An employee actually told my wife I could go ahead and have the surgery without precertification and then file “an appeal” later to try to get United Healthcare to cover its portion. United Healthcare also said it had no time frame under which they have to approve this procedure.

For this I pay $3,600 a year in insurance premiums. I had to postpone the surgery until the diligent Carolina Spine employee finally got hold of a supervisor at United Healthcare.

All of this makes me think of the big picture of health care. I fully expect the U.S. Supreme Court to overturn the health care reform case it heard last week. As a country, we are strangely married to this for-profit insurance model. Some 50 million Americans don’t even have the frustrating level of coverage I have, the one that will leave me paying $7,000 out of pocket.

People die because they don’t have insurance. They skip health care and medicines they can’t afford. People lose homes, their life savings, limbs, functionality.

And yet, God forbid we change this almighty insurance system based on maximizing profit for shareholders.

Universal payer? “It’s socialism,” people say. One person held a sign up outside the Supreme Court saying, “Obamacare is immoral.”

Forcing people to buy insurance would not be my preferred method for universal coverage, but Obama basically had to take what he could get to cover everyone.

 

To call that immoral boggles my mind.

What’s immoral is the profit margins of major insurance companies, and their executive pay packages. Besides Hemsley, United pays Chief Financial Officer David Wichmann $4.6 million, Executive Vice President Gail Boudreaux $6.4 million and Executive Vice President William Munsell $5.7 million, according to Reuters financial reporting.

That’s $27.5 million a year for four people. Money culled from our premiums.

And yet, so many think it’s un-American to take the almighty profit incentive away from an insurance company. Yes, that same incentive that essentially encourages insurance companies to prevent patients from getting pesky medical procedures, like MRIs, that may allow their doctors to see what is wrong and fix the problem.

Sure, maybe we could improve the lives of actual human beings, but we’d infringe on the free market. A health insurance CEO might not be able to buy a fourth vacation home.

I know some folks are concerned about “socialized medicine.” I’m sure on sheer principle these folks do not or will not accept Medicare coverage at age 65. There’s simply no way around this: Medicare is socialized medicine.

Here’s another hot tip: Social Security is, well, socialism. When you agree not to take your Social Security, come talk to me about socialized medicine.

Like it or not, some socialist principles make sense within an industrialized, modern, democratic framework, especially when it comes to health care.

Maybe you oppose “universal coverage.” That’s what we have now, except we all pick up the outrageous emergency room tabs for people with no insurance who wait to see a doctor until they’re critically ill. It’s just really stupid, inefficient and expensive universal coverage.

Here’s what I think: We need a system where everyone pays into a health care fund — say the first 2 percent of whatever your salary is — and everyone has access to at least a standard minimum of care. And the entity administrating the coverage plan is not profit-driven.

It works in most industrialized nations, and it hasn’t led to communism. It’s led to a better quality of life.

 

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Please visit our new web site, Visit WNC Health Advocates
The new name reflects what we do -- advocate for health care for everyone and help people access and navigate our current health care system.
While we still hold onto the memory and the generous spirit of Mike Danforth, we need people to be able to see our name and understand who we are.

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Donate here or mail your donation to Life o' Mike, PO Box 1213, Asheville, NC 28802.





Patient Pals & Family Friends

Life o' Mike has a peer support program for people with one or more serious or chronic medical issues or disabilities.

We aim to reduce isolation and fear among people who have conditions, including psychiatric illness, HIV/AIDS, diabetes, mild dementia or other cognitive disorder or disability, thereby reducing depression and complications as people learn to improve self-management of their medical conditions.

Patient Pals help alleviate feelings of isolation and frustration. They can help people develop a list of questions to ask the doctor and then accompany the person to the doctor to make sure all the questions are answered, taking notes to be sure the person understands the doctor’s answers.

Our trained volunteers also accompany their “Pals” to art exhibits, movies and walks outdoors, meet for coffee, call to check in and more.

Our Pals have experienced weight loss, improvement in diabetes, HIV, psoriasis, depression and more, just because they have someone who cares about them. Some relationships develop into longer-term friendships; other Pals move on to more independent lives.

Family Friends are there to help caregivers and other family members grow into their new role.

We need volunteers, who are asked to donate a minimum of one hour a week. Training is free and includes information on active listening, ways to help and when to know more help is needed.

And of course, we need funding.

To learn more, call Leslie Boyd at 828-243-6712 or e-mail lifeomike@gmail.com.

Life o’ Mike honors Joe Eblen


Life o' Mike presented its first Michael T. Danforth Community Service Award to Joe Eblen at a luncheon on June 8, in the Friendship Hall of First Congregational Church, 20 Oak St., Asheville.
Joe, seen here with Leslie Boyd, left, and his wife, Bobbie, has spent his life helping children and families, both as a coach and game official for more than 60 years, and as founder of Eblen Charities.

Start From Seed

Life o' Mike has a new program- Start from Seed (SFS).
SFS is a volunteer doula program aimed at providing non-medical, comprehensive support to low income, high-risk women and families of Buncombe County focusing on three areas:

1. We help new doulas with certification and training in return for their participation as a volunteer doula for SFS

2. We mentor volunteer doulas with their first few clients

3. Our volunteer doulas provide birth and postpartum doula services to low income, high risk moms, providing support and tools to empower them as a new parent.

A birth doula is a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; a postpartum doula provides emotional and practical support during the postpartum period.

Start from Seed clients are referred to us from the Buncombe County Department of Health’s Nurse-Family Partnership Program, Western North Carolina Community Health Services, and Mission Hospital. The Program is intended and designed for growing clients’ inner strength and helping them gain empowerment to help them cope with the emotional, physical and mental challenges of childbirth, labor, and motherhood.

Our new moms and their infants have many needs. If you would like to help them get off to a good start, please visit our Start from Seed web site: Start from Seed, or call Program Director Chelsea Kouns at 804-814-9946.

Events in the community

Free birth and labor classes

Peaceful Beginning Doula Services holds free birth forums, Peaceful Birth, 6:30-8 p.m. the last Thursday of every month (except November) at Spa Materna, 640 Merrimon Ave., above The Hop, in Asheville.
All are welcome, expectant women and their partners are encouraged to attend anytime during their pregnancy. We also encourage doulas and other maternal/child professionals to attend and share in the discussions. The forums are "birth circle" style, focusing on normal birth which follows the Lamaze Six Care Practices for Healthy Birth. The forums are led by certified and experienced educators.

NAMI Family-to-Family Class

NAMI of Western Carolina holds 12-week classes for families and caregivers of individuals with a severe mental illness 6-8:30 p.m. Mondays at Charles George VA Medical Center, 1100 Tunnel Road in Asheville. The course covers major mental illnesses and self-care. Registration required. Info at 828-299-9596 or rohaus@charter.net.

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