Later On

A blog written for those whose interests more or less match mine.

How American health care kills people

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Ryan Cooper writes in The Week:

Matthew Stewart owes $62,668.78 for drugs, surgeries, and other treatment. With both bankruptcy and possibly fatal liver failure looming, he doesn’t even bother opening his bills anymore, he told The Week. “There was no point. They just upset everyone,” he says.

Stewart is 29 years old, and was pursuing his Ph.D in American history at Texas Christian University until ill health forced him to withdraw. He lives in Ft. Worth, Texas, with his wife of six years, who is a junior high school teacher in a low-income district. They own their home. Before he came down with complications from cirrhosis caused by autoimmune hepatitis, he says he led a scrupulously healthy lifestyle — he does not drink or do any other non-medical drugs, he says, and was a devoted hiker before disaster struck. And he was insured — indeed, he had a gold plan from the ObamaCare exchanges, the second-best level of plan that you can get.

But now he faces imminent bankruptcy and possibly death.

The incomprehensible brutality of Stewart’s story is an object lesson in how the American health care system mercilessly crushes American citizens when they are at their weakest and most vulnerable. With a liver transplant, Stewart might well live a full life. But before he can even be eligible for one, he must thread his way through a Kafkaesque labyrinth of private and public bureaucracy — and hope he doesn’t die before he makes it through.

With cirrhosis, it’s typically just a matter of time before your liver starts failing — and you usually run into very serious complications long before total shutdown happens. (Cirrhosis is most often caused by alcohol abuse, fatty liver, or viral hepatitis, but in Stewart’s case it was just an immune system gone haywire, he says.) The liver does an astounding variety of things, but first among them is cleaning the blood of toxins and metabolic byproducts. So when it stops working properly, about the first thing that happens is a blood backup. Veins from various parts of the digestive system come together into the portal vein, which feeds blood into the liver to be cleaned. But if the liver is damaged, the blood can’t get through properly, and pressure builds up in the portal system, causing what’s called portal hypertension. That in turn can lead to ascites, a huge build-up of fluid in the belly. (In a separate process, a failing liver can also cause hepatic encephalopathy, where unprocessed waste gets into the brain and damages it.)

But a more direct result of portal hypertension is dilation of veins in the portal system, most commonly in the esophagus — creating esophageal varices. These small veins can stretch significantly under the strain, and as one might expect, sometimes they rupture.

That’s what happened to Stewart on Sept. 24, 2016.

It began feeling like an intense flu, but soon he started vomiting blood. The varices in his esophagus had burst, and were pouring blood into his stomach. To avoid an hours-long wait at the emergency room, he went to an urgent care clinic to get a quick diagnosis, and when the seriousness of his situation became clear, he was transferred to the emergency room.

That is where Stewart’s billing problems started, he says. The clinic sent him to an out-of-network hospital, because it had the first available bed, despite the fact that his in-network hospital was only a block away. “At no time was I ever asked or given any choice in what hospital the ambulance was taking me to,” he says. By that time he was nearly dead from blood loss, so surgery to close up six different hemorrhaged varices had to be started immediately.

His claim list shows 13 separate charges on this date with a sticker price totaling $73,859.36, of which his insurance covered $9,695.87, leaving him with a bill of $46,020.36 (reduced somewhat by negotiation between the insurance company and the hospital). In an emailed statement, his insurance company said, “We value all of our members and are seeking to learn more — including this member’s name — so that we can review the circumstances surrounding this situation.” The hospital that provided his emergency surgery did not respond to a request for comment.

After the surgery, Stewart spent two days in the ICU at the out-of-network hospital, then was finally transferred to the in-network one. At some point, a social worker claimed that the transfer would allow him to bill the first hospital stay as in-network, but no: “Instead, we just got separate large bills from both hospitals,” he says. . .

Continue reading. And do read the entire article. There’s a lot more, and it’s chilling. The United States government is failing its people.

Later in the article:

. . . But wait, you might be thinking. Doesn’t ObamaCare have out-of-pocket limits that would prevent this sort of thing?

It does indeed. But there are numerous loopholes that medical providers can and do take advantage of.

The biggest is . . .

Not to worry: President Trump is already working to shut down Obamacare/Affordable Care Act, and he has already worked out a plan the covers all Americans with better coverage and at a lower cost. He has not yet revealed that plan, but he definitely said that he has it. However, I feel that this may be an “alternative fact” (aka “lie”). Still, as you see at the link, he does have a plan, and it will cover all Americans and cost less.

Written by LeisureGuy

23 January 2017 at 11:31 am

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