Forman’s Personal Perspective on our Flawed Health Care System

After 60 years, we are DONE, THIS YEAR with health care reform. After that MOST Americans will accept and SUPPORT this reform as fantastic and HISTORICAL change ...
Everybody agree that status quo in health care is UNACCEPTABLE , that health care problem is our NATIONAL problem   This reform is so important : for us , our children ,next generations… for USA. I am sure that Pr Obama will not sign a health care bill that is not right or it’s not deficit neutral…

Of all the forms of inequality, injustice in health care is the most shocking and inhumane .
- Martin Luther King, Jr  

Health care plan put a patient first, and offer that American people can receive QUALITY, affordable health care with electronic medical records / telemedicine and it will cut a health care COSTS and our national deficit on long run
Health Insurance Reform is part of Health Care Reform, where Public option will be just a new
competitor with private ins companies
This is NOT a single-payer plan ( like Medicare), and Hospitals and Drugs Companies are ready to help financially, reducing there costs.  Mayo Clinic, Cleveland Clinic, Kaiser ... they already have higher quality in health care and there casts are 20 - 30 % lower than national average.

This reform “ is NOT about politics. This is about people’s lives. This is about peoples businesses. This is about our future” - Pr Obama.

My suggestions how to improve health care in USA:

1.  - prevention ( obesity, diabetes, heart disease/ hypertension, smoking , substance abuse   prevention, cancer , HIV/AIDS,  bioterrorism…);
2. - electronic medical records and TELEMEDICINE.
3. - NO health ins fraud ( cause around $ 100 billion in annual costs ).
4. -  Reduce Unnecessary Health Bureaucracy ( educate administrator to become nurse- by 2020 we will have nationwide shortage of million nurses).
5. - primary care physician first, for non emergency case ( not in ER)
6.  - Five Wishes (  Living wills + power of attorney )
7. -  Lower costs for Doctors Malpractice Insurance ( to cap the highest possible award for non-economic claims in a verdict to $250,000) ?
8. - Med- PAC program / IMAC

I completely agree with Ira Forman’s perspective. We have also been very fortunate to have good health insurance. Many years ago as self-employed in NJ we had to change policies as we got a bill at that time that would have put our annual premium payment at $20,000—sticker shock to say the least. Then in speaking with a friend of ours from our synagogue who was in the insurance business, she was able to point out that we qualified as a “group” ( the two of us) in NJ and got a much lower rate with better coverage. Our accountant also showed us that the laws were changing to allow for the self-employed to deduct their health insurance, gradually heading towards a 100%. However, before we reached that point, my husband was offered a position with the company for which he was consulting, taking this burden off.
We had also faced a minor “crisis” of coverage with a bill years ago for a hospital stay and surgery for myself. As the doctor had not made arrangements in advance to an add-on before my stay, I received a bill asking for us to pay the appendectomy which had not been pre-approved. I called the company and appealed over the phone using a simple explanation I had from a veterinarian, saying that I would have had to have hospitalized a second time, it was easier on me, and cheaper for everyone. I was put on hold and they accepted this ( my cat had been spayed and declawed at one animal hospitalization).
Health insurance with a reasonable company can be a blessing if you stay healthy, and live in a state with no gonifs at the helm. Otherwise, all bets are off the table.
We need to make the change, yesterday. The rest of the industrialized world has better coverage, better results at far less cost, with almost no aggravation. We need to join them.

It appears that the Republicans are giving people who don’t have health insurance and have a major illness two choices. One choice is bankrupting the family or the second choice is committing suicide in order to avoid bankrupting the family.

Ira Forman has highlighted yet another disastrous aspect of the current broken system of health insurance: the bureaucratic nightmare that follows major medical care. I had a rare and aggressive lymphoma that nearly killed me. Although I faced a gatekeeper physician who claimed it was all an “unknown allergy” and an insurance company that spent weeks resisting my next physician’s call for a CT scan to confirm a cancer diagnosis, I managed to survive and gain remission (this reluctance to allow a diagnosis is another story for another time). After being in 2 hospitals and a subacute facility, I amassed $250,000 in bills, and my insurance paid $114,000 after many insurance company denials and appeals from me and some of the providers. For months afterward, I continued to receive bills from $20 to $1,700 from all sorts of providers. Some were “out of network,” such as the surgeon who had performed my biopsy (try finding a surgeon in any network). Other charges came from doctors who had read x-rays while I was in a covered hospital and under a network physician’s care, and all sorts of legitimate and spurious claims. I spent about 10-30 hours per week for 6 months trying to sort out these bills, all the while on outpatient chemotherapy and disability. I learned to negotiate, plead, threaten, and document charges to such a degree that my hematologist thought I was an accountant. My insurance company was occasionally helpful, but more often than not they would deny claims based on alleged clerical errors (a physician’s code would be denied because it included or excluded an initial letter). I had to draw up tables with the charge, the “allowed” insurance fee, the co-insurance, the deductible, and other complex categories, and then I had to send these to the insurance company to prove that they were not living up to their obligations. Eventually, I had to use a lawyer to fix the last problem. I have a doctorate, and so I am able to wade through these papers, and I have become an expert in what is covered, but not everyone has gone to an Ivy League school. I think of the people who are literally thrown out of a hospital after barely responding to chemotherapy, and then being forced to take public transit to go back to this same hospital for the next 7 days, while weak and nauseous, to wait 3 hours in a waiting room so they can get an injection each day that will help boost their white blood cell count. Who has the strength to do this, and why are these people subjected to so many risks of infection due to hospital and insurance rules? We need a workable system now. There is no choice. I salute Ira Forman on conquering his illness and not forgetting how difficult things are for others.