Thursday, December 20, 2007
Pre-existing conditions preclude you from insurance
There is more evidence than ever that not having health care insurance can cost you your life. I was pretty struck by a report this morning showing that cancer patients were 1.6 times more likely to die in five years if they did not have insurance. (Watch Video)

And, here is something even more striking: A patient with grade 2 cancer has a 90 percent survival rate at five years if the patient is insured. A patient with grade 1 cancer (a better stage to have) has an 80 percent survival rate if the patient is not insured. Yes, you read that right. According to new data from the American Cancer Society, being uninsured makes you less likely to survive, even if you start with a lower-grade cancer.

There are more insurance issues raised in the study, and many of them have to do with lack of access to care. For instance, 86 percent of insured women get pap smears, compared to only 68 percent of uninsured women. And, to make matters worse, if you do develop cancer, it is often difficult to get insurance because you now have a pre-existing condition. In fact, health care proposals released by presidential candidates Rudy Giuliani, John McCain and Fred Thompson have few provisions for people to obtain insurance if they already have a medical condition. That is all the more ironic, given Mayor Giuliani's history of prostate cancer, Sen. McCain's history of melanoma and Sen. Thompson's history of lymphoma.

The insurance industry is taking steps to try to create plans for people with pre-existing conditions that are not prohibitively expensive, but for many people that relief may not come fast enough. Have you had a hard time getting insurance, even when you wanted to buy it? What did you do about it?
The best advice is preventative: develop a skill that can be used by large companies that have group medical plans. If you get hired by such a company, the group medical plan cannot deny you coverage, and you get such insurance at the group rates. Despite grumblings to the contrary, I don't think the employmee market will allow employers to stop providing medical benefits.

The advice given to young people who have known medical conditions that are currently covered by their parents' insurance is to go to obtain a college degree toward the end of becoming an an employee of a large corporation.
Those in Senate and Congress could care less since they are guaranteed life time health care coverage.

Again - the insurance company lobbyist certainly have more power then the citizens.
It's absolutely evil that in the wealthiest country in the world, we have people with terminal diseases that do not have insurance. It's a deplorable situation for which we will surely be judged by our Creator some day. We can build new stadiums for our sports teams and spend billions...just because the old one isn't updated...yet we are letting humans die without proper medical care. I just don't understand it. We pay a baffoon like Tom Cruise 20 million dollars to play pretend on the screen, but children are dying because their parents either cannot afford health insurance or the insurance companies are allowed to deny them as a bad risk. In the grand scheme of things, it would be much better to take away things like WIC coupons and welfare that are being exploited by illegals and give that money to a national health program.
Dear Dr. Gupta:

As a scientist and a clinician, you should know better than to link "uninsured cancer patients" with "higher mortality rates." The link exists, yes, but these two variables obscure truer and stronger associations.

Statistically, the uninsured are of the lower socio-economic rungs. These lots trend away from exercise (either using cardio too light for positive outcomes or lifting weights without cardio) and sophisticated nutrition. These factors are now considered medicine. We could also discuss poitive outlook, stress, and other factors.

As for access, no one in the medical field (I am) should lie about the fact that anyone can access care (even illegal immigrants). As a former free care patient, I got the same care as anyone else would.

However, as a former smoker, and now better off, I can also elect a full body scan to early-detect lung cancer, changing my likelihood of survival (up to 90%) against normative detection porbability of death (80%?). So access is a tricky issue as well. Just because one is insured does not mean one can afford the scan.

The study you discuss has some validity, but the statistics are not strong enough, and left unlinked to other factors; and the pratice of linking a title to the "conclusion" (or discussion section)is a poor substrate on which to make headlines.

Let's look at the statistics. Afterward, might I suggest a new study examining the links between antioxidant consumption and outlook and better clinical outcomes in uninsured cancer patients?

Regards,

Anonymous in Boston
The largest insurance company in my state of Iowa - Blue Cross/Blue Shield, charged inflated premium rates based on my one symptom, "heartburn", suspecting, I'm sure, future costs for Nexium, upper endoscopies, and possible surgery for esophageal cancer. I decided to get a Health Savings Account (HSA), which was almost half the cost of an inflated premium with BC/BS. Meanwhile, I am also able to receive pre-tax deductions on all my preventative care, including diagnosis and treatment with bio-identical hormones. A good article about BHRT and making sense of the WHI study can be found here: http://www.anypharmacy.com/formbhrtarticle1.pdf . I believe any future health care plan MUST include a heavy emphasis on prevention and personal responsiblity.
I'm a 31yr old low income male.
I've had a non-epileptic seizure condition that appeared when I was 10yrs old. I've not had insurance since I was 18 and became too old for my parents to keep me insured, they too were low income. I have a pre-existing condition, I work for a non-profit, and I have given up on affordable health care. I've decided that I'm just going to die a relatively early death since I am never going to get an insurance company to talk to me longer than it takes for them to find about my seizures. I'm convinced that, if it weren't for the bad press, insurance companies would have bouncers hired to throw sick people out into the street for daring to try to get coverage.
This is creepy but not surprising. Why would it surprise anyone, really? I mean, come on. I bet nobody who conducted this study ever had to go without health insurance. We who are poor are just sort of shrugging our shoulders over this one. We know how it is, and Dickens had it right, too: letting the poor and ininsured die is just another way to reduce the surplus population. What people don't realize is, who's doing the dying. In my experience, it's not the bums but the working poor. Who pay taxes but get to die an early death anyway. Call it retirement, I guess.
I am a 27 year old female who was placed on an antidepressant at age 21 and have also attended therapy sessions covered by insurance... and have been denied insurance coverage because of this. I have never been placed in a hospital for my mental health condition... and was diagnoised as having dysthmia. I am unable to get coverage privately... I ended up attending graduate school and using the student health center but still was never covered by insurance. The only way for me to be covered is to either get married and be covered under my fiance's plan at his work - or join a group plan at work and they have to cover me... I think it is a shame when people are trying to prevent acute disease of any kind and are punished for it.
Dr. Sanjay Gupta/Question: didn't know how to reach you. I recently had a PARTIAL colonoscopy. The Dr couldn't finish it because I have a
kink in my intestine. He feared tearing or rupturing it. The pro- cedure was completed via CAT Scan. 1. How accurate is that compared to the colonoscopy. 2. How can I get this KINK out of my intestine
short of surgery. 3 yrs ago I was diagnosed with IBS, but now this Dr is not so sure. I have had 2 episodes in the past 3 yrs where I've actually fallen off the toi- let while excreting waste. Some- thing to do with the vagus nerve?
Due to strong side effects from chemo I lost my job and therefore healthinsurance. No Insurance company would give me insurance for 5 years, until I am considered cancerfree. Finally I found a very expensive high risk pool insurance that will cover me until medicare starts. Without the help of my children I could not survive.
Previous to my Peace Corps service I was healthy. However, during my service I developed a chronic illness that is now supposedly covered by the Dept. of Labor's Office of Worker's Compensation.I say "supposedly" because they deny half of my bills for no explainable reason. When I was laid off from a job, I was unable to get reasonable health care coverage (and life insurance)on my own ($450+ per month for health care); I never imagined COBRA would be the affordable option. Even though my Peace Corps illness was supposedly being covered by the government, I was being penalized by health insurance providers by being offered unaffordable premiums due to an illness that was legally the federal government's responsibility. So I went to graduate school and got in a school-sponsored health care plan for much less. During this time I also tried to get life insurance for myself (to replace the one my employer had offered me) as I was recently married. But because of the illness I incurred during my Peace Corps service no insurance company would even offer me a premium to consider.
I think that we all know that insurance companies are a scam. I work as an RN in a rural town in an emergency department, and am currently a graduate student and have recently taken an active interest in the state of insuracne ocmpanies in our country. The extremely wealthy in our country can afford healthcare and the extremely poor are provided healthcare through Medicaid. The middle class sinks if they actually become ill, because insurance doesn't want to pay that much most of the time, and the co-pays and premiums add up when their is illness such as cancer that requires extensive care and diagnostic testing. I personally do not believe that insurance companies are trying to make health insurance affordable for those with pre-existing conditions. If they are, it is merely a public relations scheme to make themselves look better in the light of increasing criticism and awareness by the public. I think we need to start looking farther than the health insurance companies and start looking for another solution to lead to better outcomes for not only cancer patients, but patients with a variety of ailments.
While I had a job, I had group medical insurance. But my pre-existing condition got so bad that I lost my job, and my insurance. No one else would hire me because of my disability, so I started a home business. I now pay a substantial portion of my earnings for a policy with a huge deductible that only covers hospitalization; anything better would cost more than I earn.

It's better than nothing, but I do have to pass on some medical care and tests because they're not covered and I don't have the money.
I work for an insurance company. I understand the frustration and need of the public. There aren't many options at this time for people who have a pre-existing condition. I know that we are looking at ways on maybe in the future having plans that cater towards your own health issue. Until that time there are some things you can do to help with the cost. Each hospital, doctor's office has a billing office. You can negotiate terms before you receive treatment. And even if you already have had the treatment, you can always ask to see if a provider would accept a usual and customary in area they work in as payment in full. Because really, that provider can charge anything they want to. That's way people have insurance, one for the cap on what you will pay out, and two for the negotiated rates you receive from having the insurance. Everyone always thinks it's the big bad insurance company against everyone else, but it's really not. Our members are our top priority, we do everything we can for them. In the end, it is still a business, yes, but we still have hearts, we can hear you, but it is always left to what your policy allows. It boils down to knowing your policy, basically, knowing what you are paying for. It never ceases to amaze me how many people out there know more about their mobile phone than they know about their insurance policy. You pay for it, so take the time to read through it so you know what will be covered and what will not be covered. If you have questions, ask. Do not wait until it's too late. If you know you have a medical condition that will need lots of medical treatment, I advise that you get a job with a company, any position that will offer you the health coverage. Be careful also that, that company does not have a self-funded health insurance plan, because that can lead to the same thing about pre-existing conditions, and you might end up paying for insurance that you can not use. If you can not work, do some research on programs out there that are available to help people who cannot afford healthcare. It's an ongoing struggle we deal with everyday. My last advice for people out there is be proactive instead of reactive.
There isn't a clearer moral issue in our country. Our health care system is a sham set up for the health of corporate HMO profits.

We need true single payer universal health care NOW.
This also happens to too many people with good education, jobs, and income. HIPPAA only protects you when there is no gap in coverage or if the gap lasts less than six months. Like many other techies, I was out longer than that during the dot-bomb era when there were no jobs, and I certainly couldn't afford COBRA or private insurance. What can you do after COBRA dries up? Who can afford private insurance?

I don't need it, but it is very comforting to know that the company I currently work for does NOT exclude previous conditions. Now that I do have a health issue in the family, I need to make sure I have continuous coverage from now on, regardless of how.
The Big Lie is that everyone is being treated even if they do not have medical insurance. My son who did not have medical insurance went to the emergency ward for head trauma. They gave him a CAT scan and NO medication. So he came home and started to complain about headaches. I gave a homeopathic remedy for trauma and he recovered. The hospital continues to hound him about the bill for the CAT scan. Of course he does not go to a doctor unless he is very ill; he cannot pay for it! The doctors and the insurance companies love the current system of an official government monopoly. They make money hand over fist; why would they want it to change????
I live in WA state, and battle a chronic non-deadly medical condition. In my state there is a law that if you exhaust COBRA for 18 months after leaving your company, you are exempt from filling out the health questionnaire when applying for independent health insurance. Therefore, you cannot be denied insurance based on the pre-existing condition. Personally, I think it's really stupid that insurance companies look a people with ailments and say "Sorry, too bad...you're already sick, we won't help you because we won't make money." It's a major problem in our country.
Lee, of Yorktown, Virginia: I was a highly compensated individual contributor, one of hundreds my former employer laid off during the dot-com bust. Yes, that would be 2001. I can't even get tech companies to give me an interview. I had, and still maintain, the skills for large companies with group medical plans. Unfortunately, a skill I don't possess is stopping time; no one wants to hire someone over 50. So what if its not legal? Its never stopped companies yet.

Anonymous in Boston: You can get some care, but typically only after you've been diagnosed with disease. Any disease caught in an early stage is easier to contend with than one later. The implications of the study are that because people without insurance forgo preventive care, they are more likely to die from the disease when the symptoms become so bad they finally go to the healthcare industry for a diagnosis. Even then, do you think hospitals trying to make a buck (which would be all of them, regardless of whether they're for- or non- profit) are going to give cutting edge therapy to someone who cannot pay, or only as much as they can get by with? Further, statistically, I would say that the uninsured are more likely the middle class or the working poor, as those more poor have medicaid as their insurance. Further, your characterization of those "lots" is nothing more than pure prejudice.

Cheryl: Blue Cross/Blue Shield used to be the insurer of last resort. As such, they got those who were sickest. They've now been finding ways to abandon those sickest. How else can they stay afloat? But with an average hospital stay running $300-$500 a day, not including procedures,how long do you think you healthcare spending account will last?

Lauren: Obviously, you've made the mistake of working for a living instead of being on welfare. There, at least you'd get Medicaid. Yes, I'm being sarcastic, and not toward you. Its more important to spend those taxes on the military and business than mere citizens.

Christine: Just be glad you aren't a soldier coming back from Iraq with post-traumatic stress disorder. At least you came by your disease "naturally" rather than having the government directly inflict it on you. Government responsibility? You've got to be kidding.

Anonymous RN:Of course the insurance companies want to make insurance affordable. Otherwise, no one will pay their premiums and they'll stop making money! But seriously, insurance was a way to spread the risk of unanticipated events. As technology progresses, we can anticipate more of those events -- and that's where the problem comes in. As with any business, they don't want to lose money if they can help it. That's the only reason why some form of national health care: it once again spreads the risk out amongst the entire citizenry (since insurance companies can now avoid it). Let the upper wage-earners pay for additional health insurance above and beyond what the rest of us get!

Marlis & CFS Facs, California: Its exactly because losing a job because of illness, which is when we most need that health insurance benefit, causes us to lose that insurance that we absolutely need some form of health insurance portability.

Anonymous at the insurance company: You can try to negotiate, but they don't have to accept them. They concede to insurance companies to get a volume of business. That is the insurance company's advantage. How much volume do you get out of an individual? As a business, your numbers are your top priority. Sometimes they coincide with your members, sometimes they don't. I also hear an awful lot of stories about denied claims; are those for the members or for the numbers?

Ryan in Fort Lauderdale, FL: I agree with the universal health care, but I know many don't. They're afraid of getting less than they have now, and that's not an unreasonable fear. But I think you ascribe moral imperatives to corporations in the healthcare industry that other corporations aren't charged with. Is that right, either? A corporation is beholden to their stockholders, and if those stockholders start leaving in droves, the corporation will die as well. Not that upper management isn't overpaid, as in all corporations....

WGC: As far as I know, HIPPA refers to client confidentiality, only. But I certainly agree with the rest of your comment.

Me? I have diabetes, so I cannot get any health insurance. If I were to move to Massachusetts, would the insurance companies just charge me so much in premiums that I couldn't afford it, forcing me to break the law requiring everyone to have health insurance? I think all the candidates are just trying to perpetuate a system (private health insurance) in a form that technology has rendered impractical and unlikely. But then, the way Hillary was castigated on her health care initiative, anyone willing to buck the trend would have to be extremely brave, or brilliant, to buck the trend.
Insurance companies are a business. They can say what they want about caring, but the bottom line is money! Starting this Jan 1st, our premiums went up 25% for less than last years coverage for a very high deductible health savings account. I am a doctor, and this same insurance has not raised our reimbursement, and has cut reimbursement and coverage for services and medicines. To top it off this same company had a 10% increase in their stock value today. This same company got criticized two years ago for having the hightest paid CEO in the worl (out of all CEOs, not just insurance companies). This CEO had to step down, but still got a huge severance package. So needless to say, it is by raising their premiums, paying less to doctors, and covering less services and medicines for patients, that these companies can continue to make huge profits. However, if we forced our all the CEOs and our congressmen and women to have the same average coverage (ie no coverage, Medicare or private insurance) that Americans receive, then maybe things would get fixed.
Yes, a good advice is to try to work for a big Corporation. But sometimes it is not possible, per example my son has adebilitante illness: Crohn's disease and it is impossible for him to work at a high demanding job with long ours as Big corporation's jobs are. The Best solution is to work at your own pace and get good coverage from a private insurance. To go there we need Universal Insurance with universal coverage. As a nation we need to take care of all people thru education and health care as basic needs
Has anyone ever seen an Insurance Company Headquarters that was less than a state-of-the-art building with all the frills, including a CEO with a bird's-eye view of the world outside? I no longer vote for my political party. Give me a candidate - any candidate - who will get us a national healthcare plan and he/she has my vote!
Mark Weston
Vernon, CT
what angers me most about living in america is that it does not matter whether you have health insurance or not. You can have health insurance and still NOT get the treatment you need. Health insurance companies dicatate who gets treatment, what kind of treatment they get, etc. A girl I went to college with had some kind of abdominal cancer. She had to continue coming to school and taking classes even while she was on intense chemo just so she could stay on her parents insurance.
I am in the same boat as many of you. I was a full time professor until clinical depression put me into the hospital. I lost my job and my insurance. I have repeatedly applied for insurance and have always been denied. At one insurance agency they let me see the rules that they had to use to deny me. It said that for me to qualify for health insurance I have to be off psych drugs, not go to therapy or to see a psychiatrist for a minimum of 5 years! Now that's crazy! What is worse is that I had to take steroids (cheap) for my asthma at the same time as my psych meds and that put me in the hospital due to the interaction. My choice: stop breathing or plunge into psychotic depression. In two years I have gained a $31,000 medical bill for this and it will only get worse. Let the politicians really feel what it is like for us. Take away their health insurance and make them apply as a regular person. I wonder how many of them would be turned down?
Its tragic to think that all the years for which I have spent trainning to be an OB/Gyn boil down to the discrepancy of a non-medical person. The face of healthcare in America will never be fixed by MBA's and JD's. Physicians need to reclaim medicine for the Art it is and not the business it has become. We deny care to the least among us. As a physician I've seen too many people suffer from the financial hardship of health costs. We have to accept responsibility for the care of the poor and the needy, because at the end of the day we are all beholden to a higher power. I took an oath, and I intend to keep it.
Dr.Grupta , I am a former US Marine I am a Veitnam Era veteran back in the seventies we had steel helmets which worked shrap metal now these have no protectation at all for these soldiers and therefore they should come up some type of helmets with some type of light weight armor for these helmets so they have some type of protection. Yours Truly US Marine ,Semper Fi G.Sanchez,Cpl.
Our daughter being born at 31 weeks gestation. We are self employed, and she has been uninsurable since the day she left the hospital after 7 weeks of intensive care. She's fine now, but we have at least 4 years to go before another private insurance policy will touch her. Even a special policy for people who are uninsurable won't cover anything, because every organ system she has, has had a pre exisiting condition related to her prematurity.

Kristie
Many serious medical problems can readily be solved these days, but our discussions instead focus on insurability, which company to work for and when to start working for them (before you get sick), pre-existing conditions, insurance company profits......A close relative of mine will no longer be receiving critical medical care that she desperately needs. Why ? Because she was forced to get a new job, a perfect time for the insurance company to unload her. She's still working mind you, but just not for the 'right' company at the 'right' time. The solution ? Apparently just accept her fate and slowly pass away. The insurance companies don't care, no one seems to care. We can keep talking, but nothing will really get done. We're talking about a real person here, and unless it happens to you you'll never know the feeling.
My husband has owned a small consulting firm since 1981, employing as many as 12 people and as few as 3 (today). Few people realize how high premiums for small companies can be. We pay $3372 ($40,464 per year) per month for my husband and myself and one additional employee and his family. We are penalized because we are a small business and constantly fear being without medical insurance at a time when we need it the most.
So far the only plan I've seen that makes sense can be viewed at the PDF (not the blurb) at this site:
http://www.booklocker.com/books/3068.html
It provides a way for folks to get preventative medicine (physical with follow up for reasonable price) and real insurance--but it's catastrophic. There are a variety of cost-saving measures in the larger chapter, but this doesn't force anyone to do anything. No fines. No employers paying. It's sliding-fee scale. It's catastrophic insurance so it's affordable.
For those people that got denied
for health insurance should not feel
that bad.Iam a triathlete ,47 years
old .Iam in perfect shape I cmopete
year around in Florida.The only medicine I have taking all my life
has been lipitor for my cholesterol.
I was denied of insurance know , because blue shield and blue cross
found out that my doctor gave me 5 years ago "Avandia" as a trial drug for six month in conjunction with
lipitor.They never checked my files
to see why my doctor prescribed me
"Avandia".They just denied me , by
sending me a letter that i had a pre-condition end of chapter.This is really sad , this situation has to change .I CAN NOT IMAGINE IF YOU HAVE A PRE-CONDITION.(Cancer )
Edward Wild
Miami, Florida
I'm about to graduate from college, and I'm terrified of not having health insurance. I was born with a condition that leaves me infertile, and infertility is at the top of the list of "Preexisting Conditions" as far as insurance companies go. I don't want to work for a huge corporation with my life; I want a job that doesn't stifle my creativity and happiness. With my condition, which was completely not my fault and not even life-threatening, I can't have a lapse in insurance, because then insurance companies can deny me coverage. It's just a vicious cycle we are caught in--if I don't get a "good" job according to societal standards, I don't have health care, but if I do get that "good" job, my happiness and sanity will suffer. I can't believe that I live in one of the richest countries in the world, and I have to be worried about not having healthcare one day.
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