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Stateside: Vindicare (Part 2)

Stateside with Rosalea

Vindicare (Part 2)

I'm a bit late with this, largely because I've been feeling sick. Sick of the sight of the police smashing a guy's kidneys in Cincinatti, a sight that has been screened over and over again in news bulletins at all times of day and night. This morning one network news programme got some relatives of the dead man to speak about it, and they insisted that it didn't matter if he was on drugs or not - if he was obviously unable to process what the police were saying to him then the officers should have called in appropriate aid, not clubbed him to death.

The relatives also pointed out that over a minute and a half of the police video immediately prior to the beating has been wiped out. The District Attorney in Cincinatti has called the beating homicide, but then said that's only because the death doesn't fit any other descriptions in the city's legal code. He needs to pick his words carefully, I suppose, because of the potential for civil unrest in a city that has already seen riots triggered by police actions in the recent past.

Whatever gripes I might have about health care pale in comparison to the gripes that family must have with the Cincinatti police.

While I have little sympathy, shall we say, for a 350-pound thug on drugs, it's yet to be shown that he was a danger to anyone or that he even was a thug on drugs. And it's unconscionable of television stations to be playing that video over and over again, on a loop, especially at times when children are watching.

*** Anyway, if you're interested, there follows the information that prompted me to get my gander up about Medicare. But first a little background information on Medicare. For the word from the horse's mouth, a succinct explanation can be found at http://ssa-custhelp.ssa.gov/cgi-bin/ssa.cfg/php/enduser/std_adp.php?p_faqid=167&p_created=955634081

There being no universal health service in the United States, Medicare is the national health insurance plan that you pay into as a separate line item on your weekly paycheck. After paying into it for 10 years and reaching the age at which it kicks in, you're entitled to its benefits. It helps pay for such items as doctor's fees, outpatient hospital visits, and other medical services and supplies. Mentally and physically disabled patients are also entitled before reaching that age.

Administration of it is subcontracted out to insurance companies. In federal Region IX, which includes northern California, Medicare's subcontractor is the National Heritage Insurance Company. NHIC has the power to put any doctor's claims under "prepayment review," which means they won't be paid unless NHIC approves them. If a doctor appeals that decision it is the NHIC's Medical Director that reviews it, not an independent body.

This story, which was published in the Summer 2003 newsletter of the Physicians Organizing Committee, is about a board-certified family practitioner, Dr. Howard Thornton, who testified on behalf of a psychologist who had been wrongly charged with Medicare fraud by NHIC. Three weeks after that testimony, the POC newsletter says, both Dr. Thornton and another doctor who testified on the psychologist's behalf at a hearing before an administrative law judge, received notices that NHIC had placed all of their Medicare claims on prepayment review status.

"Deprived of income from treating his patients covered by Medicare, Dr. Thornton had to sell his office, lay off his staff, and has narrowly averted repossession of his car and foreclosure on his house," says the article. The Physicians Organizing Committee helped Thornton with his own appeal to an administrative law judge and secured a reversal of NHIC's refusal to pay Thornton for patient care services.

At the heart of NHIC's refusal was their claim that Dr Thornton made "unnecessary" visits to the intermediate care facilities and board and care homes where his mentally and physically disabled patients are living. NHIC argued that they could have travelled to see a doctor just like everybody else, and that the patients were being seen by other doctors. The judge found no inclusion in the record of any evidence of such a duplication of services "beyond bald allegations."

Now, I'm sure that Medicare fraud by doctors exists, but I'm equally sure that a health care system that allows a commercial entity to police itself and vindictively run someone out of business based on blanket judgements of what is appropriate treatment is a far greater evil. Hey, let's just throw these disabled folks on the trash heap cos they're costing us money. Who cares if they're so unable to care for themselves that they do things like use the wrong medication, as one of Thornton's patients did in the period he was unable to treat them, causing constant vomiting, which led to peptic ulcer disease?

It's not like beating up on doctors is going to get on the TV news for twenty minutes every night, now is it? And, heck, they're prevented by law from forming a union, and everyone is annoyed with doctors anyway cos they can't get to see one, on account of the insurance industry running health care. Jeez, have we got this sewn up, or what?!

ENDS

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