The State of U.S. Healthcare

America has one of the lowest ranked healthcare systems of an developed nation anywhere in the world despite being one of the most expensive. Among the top seven most industrialized nations, the U.S. is ranked dead last.

When it comes to life expectancy, America comes in at 47th among 201 countries. We average 79.4 years of age, with women living to be around 82 while men tend to live to age 77. Although that sounds pretty good, it's actually considered pretty low when compared to some of the top ranked nations such as Italy where the average age is 84.20 or any of the Scandinavian countries where most people live to around 83 years of age.

So, with the United States ranking among the lowest developed nations in terms of healthcare, who are at the top? The top three are all Asian countries, namely  Japan, Macao, and Hong Kong with overall life expectancies of 84.95, 85.51, and 85.83 respectively.  

The majority of top tier industrial nations are also in the top 20. The few exceptions include China in the 52nd spot with an average age of 78.79, Poland in 54th place with a expectancy of 78.60, and Saudi Arabia at 60th with a average expectancy of 78.10.  It should be noted that in every instance, women outlive men by an average of roughly ten years.

In terms of infant mortality, America again ranks last. The average is currently 5.4 per 1000 births, making us the highest of any top tier country. It's worth noting that as of 2021, the U.S. spent 17.8% of its  Gross Domestic Product (GDP) on healthcare, which is two times that spent by any other top industrial nation.

The primary reasons cited  is poor prenatal care such as smoking, drug and alcohol abuse, failure to take proper medications, and improper diet. Other factors include the high rate of cesarean sections as well as high rates of poverty which contributes to other health problems such as obesity, high blood pressure, heart disease, and diabetes. 

In addition, the groups most affected tend to be minorities, especially Native Americans, Black Americans, and Hispanics (as an aside, these same groups also tend to have the lowest life expectancies). 

When it comes to prescription prices, the U.S. spends more per capita than any other top tier nation. On average, we spend $1000+ per person annually on prescription drugs while average in other top tier nations is just $552 per person. At the same time, three in four Americans report being unable to afford the price of their medication. Spending on medication from 2004 through 2019 increased 69% in the U.S. while elsewhere it increased by just 41% on average.

Why is that? In part, it's because prescription drugs are, on average, nearly three times more expensive for a given drug than in any other country. A Humira Pen, for instance, used to treat inflammation in diseases like arthritis, averages nearly $5000 dollars per injection while in other industrial countries the same pen would cost about just under $3000 dollars.  The result is that many Americans are forced to chose to either do without or to ration their medication which often means not taking them as prescribed.

Another key reason is the emphasis of the healthcare industry on treatment (and thus writing more prescriptions) and less of emphasis on prevention. It also worth pointing out in other industrial nations, doctors are less time restricted when it comes to treating patients while in the U.S. physicians are typically capped at 15 minutes per individual and follow a quota system. The result is a focus on profitability and less on the long term welfare of the patient.  As the expression goes, "a cured patient is a lost customer".  

In addition, the United States also ranks at the bottom when it comes to the availability of hospital beds, and subsequently the length of the average stay of a patient. In the U.S. there are approximately 2.8 hospital beds available per 1000 individuals.

In terms of long term care, the costs per patient is the fourth  lowest at $924.00 dollars per patient. Italy is the cheapest at $422.00 dollars per patient, followed by Australia and Japan. The UK is next after the U.S. at $952 dollars. The most expensive costs per patient for long term care is the Netherlands at $1,858.00 dollars. Also among the most expensive are Sweden, Switzerland, and Germany at $1,567.00, $1559.00, and $1,445.00 respectively.

Among the other top industrial nations, that number is 4.3 beds per 1000. The lack of beds obviously affects the length of an average hospital stay. In the U.S. the typical patient is in the hospital for about 4.8 days (only the Netherlands is less, at 4.7 days). In Canada, Germany, and Switzerland is roughly 8.5 days. In France it's 9.1 days, and in South Korea it's a whopping 19.1 days! Can you imagine eating hospital food for nearly three weeks? Blah!

Lastly, we need to look at how the United States compares other industrialized countries when it comes to the availability of physicians. Based on the latest data, which is from 2019, the U.S. has least number of practicing physicians of the top 13 industrial nations.

The U.S. has just 2.6 doctors per 1000 individuals. That compares to France where the ratio is 3.2 per 1000. Australia has 3.7 per 1000 while Germany and Switzerland has 4.3. In Austria that number is 5.2 doctors available per 1000 potential patients. 

As an aside, the American healthcare system has more nurses than does comparable healthcare systems worldwide, and while the U.S. has more hospital staff than other nations, the majority of them are clerical/non-medical administrative personnel.  

As a result, the U.S. is tops when it comes to medically related administrative costs; an average of $925.00 per patient compared to an average of $204.00 among the top wealthiest countries. Sweden and Japan by comparison spend just $70.00 dollars per patient.

Lastly, what about quality of life? According the World Population Review, Northern Europeans clearly have the highest quality of life. In fact, the top ten nations are almost always include the Scandinavian countries of Iceland, Finland, Sweden, Norway, and Denmark, along with Germany, Switzerland, Netherlands, Canada, New Zealand, and Australia.

As for the United States, we currently rank 20th in the world, just behind Spain. You'll note that the countries with the highest quality of life also tend to have the longest life expectancies and the better healthcare.  

What does this say for the United States? The majority of the countries which rank higher than the U.S. in terms of life expectancy, healthcare, prescription prices, and so forth all focus on prevention first followed by treatment. They also place a greater emphasis on the overall wellbeing of the patient and less on meeting quotas or cost per patient ratios.

The majority of the countries follow a decentralized national healthcare system which is available to all its citizens. The healthcare is government managed with about 75% - 85% of the costs paid by tax revenue collected at the local and national levels. Prescription prices are often negotiated by the State rather than insurance companies or hospitals to ensure the best quality at the lowest cost.

Dental coverage for children are typically free while adults can buy dental insurance which is often subsidized by the government. There is also cost sharing between the patient and state based on the patient's income with costs being capped overall.  The costs of various medical services such as ambulances are typically bore by the State.

Hospitals and medical practices are given various financial incentives to improve efficiency and productivity. As stated previously, the State also encourages health conscious lifestyles such as regular exercise, longer vacation times and extra time off for "mental health", healthy diets, while encouraging cessation to bad health behavior such as smoking, poor diets and obesity.  

Free clinics can be found nearly everywhere, which is in part to help encourage males to seek treatment (men are notoriously for not wanting to get checkups, thus contributing to their higher mortality rate). Maternity leave is typically paid and extended to include the fathers as well.

The American healthcare system is a primarily profit driven enterprise with an emphasis on treatment and less on prevention. That has to change. While Americans are keenly tax adverse, a single payer tax system provided by the government would go a long toward improving overall healthcare, lower costs in the long run, and ensure health coverage for all, which would reduce costs now picked up by taxpayers.   

It would have the added benefit of allowing small businesses unable to afford health coverage for employees to compete with larger companies who can. Insurance can still be purchased by those looking for additional coverage.

Finally, doctors and medical professionals need to spend more time with patients and focus more on care and less on quotas. There also need to be more emphasis on mental illness treatment, which would go a long in alleviating some of the homeless problems facing communities today. Government funded research must pay along costs savings to the public. In addition, each state should negotiate prescription prices with the manufacturer to ensure patients receive the lowest cost possible for their medicine.

Meanwhile, there needs to be an additional effort made by the State and employers to encourage healthier lifestyles, including perhaps providing free or low costs classes in dietary choices, exercise, mental health, prenatal care, growing gardens, and so forth. 

 

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Deception By Religion / Trumpcare: Bad Medicine?

There is so much happening in the world right now that it's difficult to decide what to write about. Therefore, in that case, I'll run with a few trending topics. First, let's look at Europe. In England we're still seeing various acts of violence, such as individuals on motor bikes (what we might refer to as a "scooter" in the US), doing a drive by. However, instead of using a gun, they're throwing acid in the faces of their intended target. Currently, about two such incidents involving four individuals have been reported. Most of the those attacked didn't sustain any serious injuries, while one is reported to have significant injuries. What this attack reminds me of is the same cowardly attacks made on females attending school in places like Afghanistan, Iraq, and other nations where there is a radical or extremist Muslim presence. The reason, in case you're wondering, why little girls going to or returning from school would be singled out for such a horrendous attack.

One of the key tenants of radical Islam is the control of females. By that they mean utter subjugation---no driving, no voting, no showing of skin, no excursions without their husbands or male members of their families as escorts. Finally, no education. That's right. Females are not to be educated beyond a functional level; how to read and write and some nominal mathematics abilities. So, in order to discourage these girls from attending school, these cowards often attack the girls with cane poles and beat them all the way back home, or, as in this case, attack them with acid in order to disfigure them (the thought is so that no one will want to marry them. The first rule according to their religious teachings is that women are responsible for home and hearth). Therefore, since this is the kind of barbarity we see in the Middle East, plus parts of Africa and Asia, it's logical that we're dealing with the same people.

Elsewhere in England, but especially in continental Europe, there has been a number of protests by "migrants". Some are demanding that Europe accept Sharia law only; some are demanding that non-Muslim European women cover up, plus demands to stop producing pork products as well as liquor, including beer and wine. Interestingly, many are protesting the quality of their free food and free government housing (which, in most cases, had been the homes of poor citizens just a few days earlier). Sadly, low income nationals been forced out in order to make room for the immigrants, who are now demanding better housing (a few are demanding better medical care as well , of which they aren't paying for either). I would be remiss if I didn't mention the attacks on young girls and women in subways, parks, swimming pools, and so forth. When---and if--- confronted by the police, the men usually claim that they didn't understand the cultural restrictions or that they were "offended" and so they were just "protecting" the women in accordance with their religion ( I would love to know how they explain the gang rapes or rape beatings). Naturally, they should know right from wrong, so I guess they are just playing the cops for fools, who----along with the corporate media---seem to be buying it. Perhaps it will take a few journalists, cops, or their family members being beaten or repeatedly raped to drive home the danger.

On the home front, we again have the issue of healthcare; the zombie legislation which refuses to die. Under this recent incarnation, the Republican controlled House didn't have enough votes to pass it through. However, that's really not the issue. If you'll recall, when the Affordable Care Act ("Obamacare") was first proposed, the Republicans fought it tooth and nail; citing a whole host reasons why it was a bad bill---some of which proved to be true. However, it took the US Supreme Court, in violation of role per the Constitution, to turn the bill for healthcare into a tax before it could be ushered through. Meanwhile, the Republican House leaders promised to work on a "solution" which would be ready and "in the drawer", ready to pull out and pass as soon as they had the votes to get it through Congress.

Well, they now have the firepower. They control both houses of Congress and the presidency. However, it's now quite obvious that there was no one working on a replacement bill during all these years despite promises to the contrary. There was no new healthcare bill to "pull out of the drawer". What they have is a half-ass bill designed to lift up and protect their corporate masters. Meanwhile, those at the lower social/economic ladder face the very real possibility of losing coverage all together. Now, no matter what you say about Obamacare---pro or anti---you have to admit that this was the first time so many people were finally covered; some for the first in their lives. In addition, Obamacare at protected not just the poor or working poor (formerly known as the Middle Class), it provided coverage for seniors. Seniors, in case you don't know it, is the largest demographic in America based on age (currently seniors are comprised of the WWII generation aka "the greatest generation", the Silents who are their children, and now, the Babyboomers, who are now entering retirement.

From what I've heard about the latest healthcare bill, which uses the moniker "Trumpcare", was that most of those mentioned above would be crap out of luck when it comes to coverage, especially pre-existing coverage. In addition, the list of prescriptions not covered are expected to be expanded., meaning that individuals will have to pay for it out of pocket, when, given the astronomical costs of some medication, will be all but impossible. While a few have taken to going to Mexico or Canada where the medication is cheaper, are often taking a gamble on being stopped at the border or receiving inferior medication. It seems that the only ones who actually benefited from "Trumpcare" were business owners and the pharmaceutical industry.

I wonder how many people will have to die or suffer the consequences of doing without their medicines before Congress, the White House, the media and their corporate owners finally create a realistic plan? Personally, I favor a single payer. This would provide basic coverage for everyone irrespective of previous injuries or what medication they're on. It would also allow individuals and businesses the opportunity to purchase additional coverage separately. In this way, those who don't need extra insurance will have basic coverage while those who need more or specialized coverage can buy it on the open market. Lastly, whatever type of insurance plan Congress settles on, I think it should be mandatory that all government employees including those elected to office have to participate in. In other words, Congress, the Presidency, the Judiciary, and all the bureaucrats cannot exempt themselves.

Finally, Russia. Specifically, Russian interference in the 2017 Presidential Election. Frankly, as far as I'm concerned, this is a non-starter. I think this is all about trying to find an explanation for why Hillary Clinton was denied her coronation. Disagree? Let's look at the "7 Stages of Grief". First, there is Shock. I think we saw that all over CNN, MSNBC, ABC, and the other corporate news stations, not to mention all the various talking heads from Rachael Maddow to "The View". After that we had Denial. There were hundreds if not thousands of protesters chanting that Trump wasn't "their" President, with others demanding recounts or wanting to find something---anything--- to impeach trump on. Many boycotted the inauguration and parade (a few were childish enough to post pictures comparing Obama's inaugural turnout with Trumps). Next comes Anger. That's obvious enough with idiots trying to block traffic, demands "safe spaces", claims of "offended" , riots (err, I mean "protests"), trying to shout out or attack anyone who disagrees with them (refusal of free speech) and so forth.

After Anger, we come to Bargaining. Bargaining, in this connotation, it means trying to find ways around what happened. This may including refusing to cooperated in any way possible, or providing excuses for what happened (in this case, "the Russians must have done it". Once we realize that we can't bargain or negotiate our way out of the situation, we slid into Depression. I think that's where many Democrats are now. These Democrats are coming to terms with the realization that they had a crappy candidate; one that was full of flaws... including some treasonable crimes as well as actions which shows either a complete lack of intelligence or hubris such improper handling of secured information, refusal to use secured servers, lackadaisical handling of cell phones and e-mails just to mention a few.

Next on the Grief Hierarchy comes Testing. This is perhaps the most critical step now that we've had an opportunity to get ticked off and an opportunity to vent and point fingers and so forth. Testing means you understand what happened, and to a degree, why. You know that you can't go back and change events. Things are as they are. However, this stage is where we re-evaluate what went wrong and why. We know our political system is broken beyond repair (and our social and economic systems are severely damaged and isn't functioning properly). This is where change happens. It's where we take a measure of ourselves. In many cases, it's where decisions to jettison the existing system is collectively agreed upon; where we might look to third parties or Independent candidates; where we decide on a new social and/or economic contract) or how we get our news and other information. A great deal can and often does happen in this stage.

Finally we come to Acceptance. By the time we reach this stage, we (hopefully) have got our collective act together. We've accepted what happened...and why. We've learned where to place the blame (which, more often than not, is mostly on ourselves). In addition, we've come to a consensus on how to proceed. We've changed the rules. We've decided on a collective direction. Lastly, this is the stage where we look around and see where how much we've changed or adapted. It's at this stage where we've realized how much we've grown. I think by the time we've reached this stage, we will have accepted the notion that a woman...or anyone of any race, religion, or gender, has the potential to become President.

It's also at this stage where we accept the fact that we simply misjudged the quality our earlier choice. I think too that by the time we reach this change, we would have found a way to re-spark our nation; where we have found and implemented a new system which works for all of us, which means doing away our current form of government, a neo-fascist Oligarchy, complete with its growing surveillance apparatus. To do nothing is a guarantee that it will continue to grow like a cancer and our former constitutional republic will be found only in the history books.

KYNECT: My Experience with Kentucky's Health Exchange Network

It's not my habit or even inclination to write about local or state issues. I usually try to leave that to those who have the interest and, frankly, the connections. As the editor of Another Opinion, I try to keep the focus on the "big picture"; national and international events which affect everyone. I least of all like to write about myself. To be honest, I don't think I'm that interesting. But I must make an exception this time. This is a personal story which has to be told, not for my sake but the sake of others affected by Kentucky's health exchange, KYNECT, which has often (and erroneously) been billed as "America's Model Health Exchange" by former Governor Steve Beshear in response to the Affordable Care Act or as it's more commonly called, "Obamacare"; the healthcare law that isn't. This isn't my first go around with KYNECT, only the most recent. I will try to avoid using identifiable or real names of those I've dealt since many, if not all, are still employed and I have no bone to pick with any of them or desire to cause them harm in any way. Most were simply trying to do their job to the best of their ability and simply either lacked the proper training or authority. However, it was the system itself and the bureaucracy built around it which plays the primary role as villain in this little drama. So, with further ado, let's begin.

Like most Americans, one of the first projects I begin working on following New Year's, is gathering and sorting through piles of receipts, notes, and other documents in order to file my taxes; an annual ritual that most Americans both curse and gleefully anticipate like kids at Christmas in the hopes that dear ole "Uncle Sam" will be sending them money for new washers or dryers, or down payments on cars, boats, vacations, or whatever with stopping to realize that it's their money in the first place that they were denied use of for a year, but I digress. After dutifully gather all my paperwork together for 2015, I headed off to a professional tax preparer on February 13th. After dropping everything off and quick review, I headed home knowing that's one more problem off my plate and secure in the knowledge that they'll be done right while I focus on more mundane tasks like cleaning the garage. Alas, that wasn't to be this year. By the time I had arrived home, the tax preparer had called and left a message for me to call back. "That can't good" I thought, and I was right.

It turned out that KYNECT had sent a 1095A form, which meant nothing to me. As the tax expert matter-of-factly explained, it meant that we had been enrolled in a insurance program for which we didn't qualify for based on my wife's part time job and income reported on her W2. She recommended that I call KYNECT and get a corrected 1095B form, which is what KYNECT should have provided based on the insurance program we were enrolled in. Sounded simple enough. So, I called and after a brief hold spoke with a rather chipper customer service representative named Shayne. I explained the problem to Shayne, who politely said they would correct the problem and get a 1095B out to me as soon as possible. A few days later, almost miraculously I received a 1095B and immediately I dropped it off at the tax preparers' office. Once more, I had a phone message waiting for me by the time I got back home. So, feeling like a kindergartener who got caught skipping down the hall, I called her back. As it turned out, the 1095B they sent went with the 1095B and so it's wrong too. She explained that the 1095A should be zeroed out since we never received supplemented coverage KYNECT was showing and the 1095B should reflect the policy we actually did have. So, on February 23rd, I called and spoke with Jasmine at KYNECT and gave her my story. Jasmine promised to review with her supervisor and send a corrected 1095A and 1095B, but again, I received the same incorrect forms a few days later.

On March 2nd, I called an explained the situation again to the poor unsuspecting customer care representative who had the misfortune to answer the call. She reviewed the notes in the system and refreshingly admitted that this was above her head and then politely asked if she could place me on hold while she spoke to her supervisor. Jackie. No problem. I explained to Jackie the situation and my justifiable frustration. Jackie said she had reviewed the notes and thought she understood the problem and had a possible solution. According to Jackie, either the system or someone, had entered our annual income into the wrong column. The yearly income, based on my wife's part time job, was mistakenly shown as our January 2015 income. This automatically kicked us out of our insurance plan and into a supplemented insurance plan, at least for a few weeks when the mistake was probably caught by someone reviewing the data. The system showed that we were placed in plan which showed no income for January 30th to February 1st, and then back into our original plan starting February 2 through the rest of the year. Confusing, but at least we had an explanation. All that was needed, according to Jackie, was to transfer me to the folks who handled 1095A forms and have them zero out the January 1st through the 30th. That would automatically generate a corrected 1095A form and would generate a correct 1095B form. Jackie also said she would make sure this would be amply detailed so everyone would know what happened. Hallelujah!

So, Jackie transferred me to the folks who handled those dreaded 1095A forms. As it turned out, I spoke with a very sympathetic Amanda. Amanda asked for my claim number and as I started to explain, she said she had just read Jackie's beautifully detailed notes and knew just what to do. Amanda said she had already entered a ticket to have the 1095A form, the bane of my existence at this point, zeroed out. I should receive a new, and hopefully correct, 1095B form. To be sure, Amanda transferred me to Shasha in the 1095B department. Again, they were on the ball. Shasha had the information from Jackie and Amanda, and assured me a new and accurate 1095B should be generated and on its way to me shortly. For the first time in weeks, I had a good feeling about this. I immediately called and let my tax preparer know the good news. Actually, I think she was almost as pleased as I was (probably because she knew she was going to get this off her desk and paid).

On March 7th, I received a call from Jackie at KYNECT to make sure everything was taken care of. I brought her up to date and thanked her for help. I deeply appreciated everything she had done. On March 10th, I called to confirm that everything was proceeding as discussed and there were no hiccups. John, another one of the customer care reps, was a bit less friendly (personally, I think he saw all the notes and was afraid I was going to ask him a question). John confirmed that the revisions were being processed and there was a ticket to expedite the handling of my claim. "Excellent" I thought, and that's when the other shoe dropped...with a dull pain-in-the-pit-of-my-stomach thud.

On the morning of March 17th, I received a phone call from Jeanette at KYNECT. Apparently she must work in the 1095A department since she said he supervisor had asked her to call me and see "if I really wanted to have the 1095A form corrected". What? I asked Jeanette if she or her supervisor had read the notes, and she said her supervisor had but was wanting to know if I really wanted to do this? She went on to say that their system showed that we didn't qualify for the program we were in due to our "substantial income for the month of January 2015" and that's why we were placed in the other supplemented insurance plan which generated the 1095A. I think that for a moment I was actually numb. How could this be happening...again? Didn't anyone actually read the notes? Why were they just now working on this---10 days later? I explained as rationally and briefly as I could what the error was and what had been done, but somehow I don't think I was getting through. In her eyes, I was making the claim that their system was wrong; it was flawed, but I suspect she was thinking that it was I who was wrong.

Immediately, I gathered up all my documentation and notes and called KYNECT. Enough was enough. The unfortunate soul who answered for KYNECT was Jaz. She dutifully asked for my claim number and then...silence. I think she was just as stymied by all the notes as I was in knowing where to begin. As I started to explain, she very politely asked to place me on hold while she spoke with her supervisor. After a brief hold, Jaz came back on and in a refreshingly honest tone said that this was over her head and recommended I speak with her supervisor, and so I spoke with Dannie. Dannie introduced herself and asked if she could place me on hold for a few minutes while she read all the notes. "No problem" I said. I let her know that I wanted someone who knew the facts before we went any further. After about five minutes, she came back and said she had read through the notes. She asked if I had ever been referred over to Community Based Services (CBS), which oversaw our insurance plan. I said no and she said that she hadn't seen anything either. She explained that she understood everything that had happened but was flabbergasted that I hadn't been referred to CBS since they had oversight over our plan. She went on to say that only CBS could make the correction which would then flow over to KYNECT's 1095A and B departments where new forms could be generated. Until CBS made the change, the system would keep editing out the corrections and perpetuate the original error. This was now March 24th and I had started the process on February 15th. I had wasted weeks of effort.

So, Dannie transferred me to Community Based Services where, after an hour and a half wait, I spoke with a cordial Jane. Jane read through the mass of notes and was surprised that no one---not customer service reps or supervisors or their supervisors---no one had thought to refer me to them. We discussed the problem in detail and she issued a ticket for an immediate correction. She said the 1095A would have to be backdated, if possible since we never had (or knew of) the tax credit, as a result of being bumped out of our original insurance plan, and in fact, had never enrolled new plan. The insurance company which underwrote the new plan didn't have a new member ID number for us, and obviously we never received a new insurance card. We never even received notice of a change in plans. Nothing. As I advised Jane, we, in fact, had continued to use our original insurance card as always with no problems. The problem, however, for us was whether the system would allow a backdating of the entry to correct their error. She also pointed out that this wasn't a system error. It was human error in making a data entry. Some minimum wage summer help goofed and now I'm paying the price I thought to myself. Jane promised to follow up, however reminded me that nearly the public safety net for the State of Kentucky was in turmoil due to errors generated by the recent mergers of social programs which had caused thousands of individuals to bumped out of programs on which they depended, such as food stamps, housing assistance, natal care, and so forth. My problem, as important as it was, would not be considered priority. Jane suggested that I give KYNECT a call in a few hours. By then they should had the change from her side and could reprint a corrected 1095A and B. She added that KYNECT could read their notes since they were on the same system (besides, CBS can read KYNECT's notes).

About three hours later, I called KYNECT and spoke with Aretha. She said there were no changes showing; nothing. I asked her to check with her supervisor who may have a higher access. She came back and said that KYNECT was unable to read anything from CBS. Jane had recommended that I request a letter from KYNECT explaining their error for my tax records. Aretha said that under HIPAA guidelines that was not possible, even with a oral or written request. In short, KYNECT wasn't going to step up and own their mistake. At that point, I was fed up. I was tired. I had done everything in my power to get this resolved but nothing I did worked. I was dealing with a bunch of apparatchiks that would have made the Soviet Union proud. Since I know a few people on the executive side of State government, I felt the time had come to reach out for assistance. I contacted someone I knew and as briefly as I could explained what had happened and asked if there was anything he could do to help. I made sure this was done formally to both protect each other as well as to give it the weight of a formal request for assistance.

On March 30th, I was pleasantly surprised with a call from the Kentucky Cabinet of Health and Human Services. After a bit of clutter about what their system was still showing, etc, I was able to explain what had happened and needed to happen. I was told I would need a special letter of exemption, which she would discuss with her boss about providing. However, she never had heard of a problem quite like this before and acknowledged that she didn't know what, ultimately, they could do. I was promised a call back as soon as she knew something. I was hopeful that this bureaucratic nightmare was about over but I knew better than to get my hopes up again, and as it turned out, I was right.

Approximately a week or so later, I received another letter from KYNECT. It was the same incorrect forms as before showing the same incorrect coverage and the same incorrect income. After all this time, nothing whatsoever had been accomplished. I phoned my contact at CHHS to ask what had happened. She said that coverage apparently became available as a result of the income entry error. There was no coverage actually provided, though the company which had picked us up did, apparently, received payment from the State. I reminded her that no new member number was ever assigned. No notice of the change in coverage was ever provided. There had been no contact from either the new insurance provider or by me with KYNECT. In fact, I had received a notice from KYNECT in December 2014 advising that my coverage would continue as before for 2015. After the error was ultimately caught and corrected late January, the money was returned by the new insurance company to the State and we were resigned our original coverage as if nothing had happened, except for the incorrect 1095A and 1095B.

I asked how we was assigned the new provider and was advised that either I or someone else had selected them since the system doesn't automatically assign individuals (at this point, I don't think they know what the system actually does and doesn't do). I reminded her that I hadn't contacted anyone at all with KYNECT in 2015 and I keep very detailed notes of my dealings with KYNECT. They had caused me enough problems once before, in 2013, so the less I had to deal with them the better as far as I was concerned. So, apparently someone at KYNECT---perhaps that same minimum wage summer help---made the selection for us. As for backdating the system to correct them original program, they can't. There is no mechanism in the system to allow this type of correction. After nearly two months of dealing with this so-called "health exchange model", I was stuck with their mistake. No ability to correct data errors. No letter of exemption. No letter acknowledging their mistake. Nothing.

Most of those I dealt with were helpful, and like many State and local government employees overworked, stressed, and often underpaid while the department administrators are very well compensated and usually have linebackers to keep them separated from the common riff-raff. Of course some entry level employees are rude, unproductive, and unprofessional. I didn't find that here, though some were obviously totally lost. I didn't get what I needed, a correction of KYNECT's original, a correct 1095A and 1095B form, or written acknowledgement of their error, I wouldn't describe this as a "loss". I was successful in exposing the often ignored individual employees who went above and beyond to help me address a problem not of my making as well as highlighting failures in KYNECT's employee training, in its bureaucratic roadblocks designed to protect KYNECT's administration, and perhaps most importantly, in revealing a flawed system which lacks the proper programming to allow its users the ability to correct errors. I am sure there will be those who won't care one bit for this being exposed to the public. That's too bad since it's our tax dollars which are paying for this. If KYNECT is a "model" of a healthcare exchange, it's the model of what could be a successful exchange rather than of one that is.

Having the Stones to Take on Goliath

As readers of Another Opinion know, I've been engaged in a battle Kynect (Kentucky's "model" insurance exchange) and with Humana, to which I've been assigned. Just to briefly recap, my wife and I applied for insurance through the Kentucky insurance exchange known as "Kynect" (we have the distinction of being the second applicants to register when it went operational in August 2013). Somehow we managed to find every computer glitch and SNAFU in the system despite repeated assurances to the world by Governor Beshear that program was working without any hitches. By early October, our status had been elevated to the highest tier and I found myself dealing with programmers, systems analysts, and systems designers as they attempted to create "work arounds" in their programming and a host of other corrections.

Finally, by February 2014, things had settled down. Since we were enrolled in the system at the end of 2013, we were permitted to pick our start date for coverage to begin. We could chose from January, February or March. Since January had past and we had no medical bills worth any note, and as February was about over, we opted from March. However, "someone" at Kynect decided, when entering the information, that we really meant to say April instead of March, and changed our start date so we ended up absorbing medical bills for March (in all fairness, the senior manager at Kynect with whom we had been working gave us the option of correcting it back to March, however, the time required would have put us well into April anyway, so we opted just to "eat" the costs). Nevertheless, we ended up with some pretty good insurance, but no good deed goes unpunished, especially when dealing with the government.

At the end of 2014, we started getting notices from Kynect saying our coverage was changing (and apparently without our consent). I called our insurance provider several times over the next 45 or so days and was "assured" that our coverage was not changing and we should ignore the notices received from Kynect; we would keep our existing coverage we were repeatedly told. Finally, in early February 2015, I phoned Kynect to see what was going on. Well, it seems that their income calculation formula had changed and we were being removed from our insurance provider and transferred to Humana. Despite my protestations, we were moved in mid-February. At the same time, we received notices from our (now) former provider that our premiums were about to expire (Kynect paid a portion and we paid the balance). Although I repeatedly explained what had happened and offered to fax or email our notices from Kynect, I was advised that my offer (and my explanation) were appreciated but not acceptable. They needed "official" notice direct for Kynect. "Okey dokey" I said, and promptly contacted Kynect to (again) express my frustration and relay their request. I was told that an official notice will be sent, however, an "advisement" had already been issued.

Meanwhile, I discovered that despite Kynect's repeated promises (parroting Obama's) that I could keep my doctors, that in the event I

couldn't, my new carrier would pay for any prescriptions and tests. I, however, would be responsible for paying the office visit. Needless to say, I was dismayed when my primary doctor of 32 years (and who is the area's only known sub-specialist) wouldn't see me when I showed up for my scheduled appointment. I was told that I couldn't even pay cash money for the visit, and to jab the knife a little deeper, my doctor could not write me any more prescriptions while I searched for his replacement. Once my refills ran out, I was, to use the proper medical terminology, screwed. As soon as I got home, I immediately phoned Kynect. Again, they offered their heartfelt and most sincere apologies, but there was nothing that could do about changing the insurer. It was suggested to connect my new provider, Humana, to see if they could locate a doctor for me. "Fat chance" I thought as I said "thank you" as politely as I could muster and hung up the phone.

So I contacted Humana's Customer Service Department. After going through a battery of options to select from (which included what language I wanted---I will never ever press a button for English as long as I live in this country), and a ten minute wait, I finally spoke with a living breathing person. After explaining my situation (while listening to timely interjections of "we're sorry for your inconvenience), I was given a list of six doctors for me to call. I quickly learned that none of these were specialist of the type I needed, but it didn't matter. None were accepting Humana. So, for the next two months, I made my daily calls with the latest of doctors Human had given me, but I jump ahead of myself.

Somewhere along the third week, I managed to get lucky. One of the customer representatives I spoke with (and whose first language was apparently English), blurted out near the end of one of my frustrated phone calls that I could submit a "Continuing Patient Care Request" and then almost as an afterthought, asked if I would like to do so. "Hell yeah" I said. So together---her writing out the synopsis while I provided my medical history, prescriptions, and reason for my request. When we ended, she said it would take approximately 7 to 10 days to get a decision (really? That was like a sleepover by this time). So while I waited, I continued to make my calls and get my daily rejections only to call Humana and get my next list of six doctors with the names sounding less and less familiar by the day from the ever changing representatives (after, of course, having to repeat my story). Some of the rejections were due to the physician winding down their practice; moved out of state; or were simply located in the wrong part of the state; wrong specialty; or simply was not accepting Humana any longer.

Finally, the tenth day came and I was on the phone for what I hoped would be my approval. However, as if to throw salt on the previously mentioned proverbial knife wound, I was told that no decision had been reached yet, so in addition to calling for my list of six, I now had to ask for status updates (as an aside, I was also providing them with updates on the doctors whose names they had given me. Evidently their list hadn't been updated in quiet awhile). Then it came.

I had been reading when the phone rang. I started to ignore the call, figuring it was another solicitor calling, despite my being on the "No Call" list, when I noticed it was my (now) former primary doctor's office calling. So I answered, expecting to hear some other piece of bad news. I don't know if I can correctly express my emotion or thoughts as I was informed that they had just concluded a series of conference calls with my current provider and given my medical needs and length of time I've been with their office, my request was approved. She was calling as quickly as possible to let me know and schedule an appointment as soon as I wanted. I remember being instantly relieved; excited; angry at having been put through the hoops; the corporate and government bureaucracy, that I must of had her repeat herself two or three times (I don't she minded. She knew me from all these years and how much I had fought this).

So, we scheduled an appointment and she explain that my efforts also resulted in a change in policy, both for their offices as well

as for Humana's that would allow longstanding patients to remain with their primary care physician provided the physician was willing to keep the patient on. I didn't feel the need to gloat but I was quietly pleased to know that my efforts may also be helpful to others in a similar position as mine. Most people would have given up I realize, but I not one of those people. I don't believe in giving up the fight if the cause is just, be it for me or for someone else. I've been a community and political activist for well over 35 years. I've also helped countless numbers of individuals take on their own "Goliath" over the decades (while "Goliath" is a good, if not common, analogy, I'm reminded more of Odysseus and the Cyclops, Polyhemus, and in particular Odysseus's response as he sailed away; having outwitted this son of Poseidon). I did it from elementary school on; while in the military; in college; and in every job I ever had. It's simply my nature I guess.

As an comical aside, remember those notices I had been receiving from my the original insurance provider mentioned above? Well, I continue to receive them, advising me that my premium remain due while I continue to advise them that I was removed by Kynect at the end of January. Meanwhile, I've checked with Kynect and have been assured that they have been repeatedly notified of my removal from their policy (I was even provided a reference number which I had sent on). Despite their disinterest in my notices from Kynect, I faxed of copies to them all the same. Just a few days ago, I received a new set of membership cards. You just have to love corporate bureaucracy.


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Is there a Doctor in the House? No Seriously....Is there?

It's amazing how something so simple as finding a physician can suddenly become so difficult. As I'm sure all the regular readers of A/O know, I've been having an ongoing series of problems with the insurance assigned to us by Kynect, the Kentucky healthcare exchange which was modeled after Obamacare. Supposedly, Kynect was going to make our lives so much more easier when it came to getting insurance. It was supposed to evaluate our healthcare needs, income levels, and provide a list of potential plans to select from. In some instances, it also picks up partial coverage. After a pretty rough start (I had initially applied in August 2013 but didn't get coverage until April 2014), I was pretty pleased with the coverage. Kynect picked up a portion of the premium while we paid for the rest. The quality was good and there were no problems with our doctors or prescriptions. By the end of 2014, I started receiving notices that my coverage would soon be changing. Puzzled, I contacted the insurance company. They assured me that my coverage remained the same, although the name of the plan was changing, that was all and I should ignore the notices, which I did. However, I received a second and then a third notice. I contacted the insurance carrier again and got the same response. I decided to contact Kynect this time.

Well, it turned out that Kynect was changing my coverage and my insurance provider...effective March 2015. "Why?" I asked. Because there had been a change in their income formulation. I advised the "navigator", as Kynect likes to call its customer service folks, that nothing had changed on my part. However, the change in calculation was on their end and as a result, I couldn't keep my current provider. Needless to say, I wasn't happy. At that point, I was transferred to a new department; one in which I would have to deal with from here on out.

While I found the individuals at Kynect to be polite and somewhat helpful, they maintained that their hands were tied and there was nothing they could do. I had the choice of accepting the new provider they assigned or pay full price for coverage on the open market, which, they said, would be in the neighborhood of about $2500.00 per month (an awfully expensive neighborhood I thought to myself). However, on the upside (as if this was actually an "upside), I could still pay for any office visits if my doctor didn't accept the insurance; they would still pay for any lab work or x-rays.

Well, as it turned out, I had a upcoming visit to my primary doctor of 32 years for my annual physical in a few weeks so I decided to wait and see what happens. After all, I had been told there wouldn't be any problems and I would lose my primary doctor. When I showed up, I was told they no longer accepted my insurance provider effective the first of January. Not a problem I thought. I told the receptionist that I would go ahead and pay cash for the visit. "Sorry, but you can't do that" she said. She went on to tell me that under this policy, it was either accepted or I walk. I was not allowed to pay cash, check, or even credit card for the office visit. To do so, I was further informed, would be considered "fraud". WTH? So, I left feeling slightly embarrassed and more than a little flustered. Because of a change in policy calculation that I neither had anything to do with or knew about, I lost the insurance policy I liked and in the process my primary doctor of 32 years, and, oh by the way, what about my prescriptions?

After I got home, I called Kynect to vent. I was told there was nothing they could do and it was suggested I call the new insurance provider, which I did. I explained the situation to that first poor soul who had the misfortune to get my call. Despite the continuous "I'm sorry" which I concluded was written into a script somewhere to sound sympathetic, there was nothing she could do. So, once again, I was transferred to another department which was a near carbon copy of the first. Finally, I managed to work my way up the food chain, where I was told I could submit a "Continuation of Patient Care" form if I wanted to. Seriously? Hell yeah I wanted too! After completing the process with my newly found best friend, I was warned that this review process could take up to 7 to 10 days and I should be patient (little did she know!).

The 10 days came and went without a word, so once more I was on the phone. I called everyday for almost two weeks beyond their 10 day cutoff date. Finally, I heard back. I was told that they wouldn't allow me to keep my primary doctor. I had previously stressed that not only was this my doctor of 32 years, he's also a subspecialist and as far as I knew, the only one around! While my now former bestie went on to repeatedly apologize, she managed to work in that there were no appeals, but they would be happy to help me find a new doctor. Really? Someone who is a subspecialist? Well, no I was told, but they may be just as good! It was at that point I started to wonder just how bad prison food really was.

Well, to make a much longer story more manageable, I've called some 24 doctors now and there's been no takers. The first six were GPs (which I didn't need or want). Most of the doctors weren't accepting new patients; some acknowledged up front they couldn't treat me; and the rest were a hodgepodge of winding down their practice, not being able to understand them or their staff, and one who had been repeatedly cited by the Kentucky Medical Board. Where are the doctors? What good does it do me to have insurance but no doctors? Is the game now to find competent care? Am I going to have this same problem with hospitals or outpatient care? Sigh. So, I called the insurance company again and as usual, had to bring ever-changing customer service rep up-to-date (she also put me on hold for about 10 minutes while she read the notes on my case. I chuckled to myself as I envisioned her cursing her bad luck).

When she returned and after the obligatory "I'm sorry for the problems you've encountered", we got down to business. I told her that I needed more doctors. She suggested that I give her the names of those I called; it might make things go a little faster. I was again given six more names (and with each their names got more difficult to pronounce). She then asked me how I was doing on my prescriptions. I acknowledged that I was getting low. She asked what I was taking, which I happily provided. She then put me on hold while she spoke with their in-house pharmacy. While I was on hold, I blissfully thought to myself that maybe, just maybe, they could help me with this problem resolved (such are the straws of desperation made of).

When she came back (and apologized again), our conversation began anew. First, she read back to me each of prescriptions, milligrams, and frequency I was taking them (oh boy I thought, maybe the gray clouds were finally clearing). I dutifully confirmed each one and what they were for and for how long I've taken each. After we completed the inventory process, she started reading back each one from the top then informed me that I would need to get a new prescription from your doctor. Huh? "I have to get new prescriptions?" I asked. "Yes" she said. "I don't have a primary doctor" I said. "How did you get the medication?" she asked. "From my primary doctor". "You just said you didn't have a primary doctor" she said. "I don't know. You all won't let me see him any longer". "Why?" she asked. "Because he doesn't accept your insurance " I explained. "Then you can't see him". "I know" I said, "and I can't pay cash for the office visit right?". "Under our policy, you can't pay cash for the office visit. It would be considered fraud". "I know" I said. "So, how do I get my prescriptions refilled?" I asked. "From your doctor". "But he doesn't accept your insurance" I said. "Then you

can't see him" came her deadpan response.

As for one prescription in particular, she said the doctor would need to call and get permission to write the prescription first. "Why?" I asked. "Because of the nature of the medication". "But I've been taking it for close to 10 years and it's the only thing we found that works" I said. "Would you like to speak with our in-house nurses?" she asked. "Why?" "So they can explain your medications to you" she answered. "You mean the medication I've been taking for 10 years or the other medications I've been taking for the last 15 or so years?". "Yes sir, those". I politely explained that I most likely know more about my medications than their in-house nurses. "If I did, can they refill them?" I asked. "No sir, you have to see your doctor for that" in perfect monotone. Then it dawned on me. Those weren't gray clouds over my head. They were pigeons.

The Great Obamacare Circle Jerk: The Final Round

I'm one who really hates leaving loose ends. Call it a quirk of mine. I just like finishing whatever I start, particularly if there is the potential to learn something new. So on that note, let me take you back to a previous article of mine,"The Great Obamacare Circle Jerk", which I posted on April 12. As you recall, I had been stripped of my primary healthcare provider of nearly 33 years by my state's healthcare exchange and forced in to a new healthcare program which I didn't want. My wife and I were completely happy with what we had.

I filed a "Continuity of Care" request, which was submitted to the insurance company's medical review board. I pointed out that my primary doctor and I had a strong and unique relation which stretched back close to 33 years. I stressed that he became the kind of subspecialist I needed as a result of my rather unique set of medical circumstances, and that he was perhaps the only doctor in the area with this subspecialty. He treated me as an equal partner in my care; none of this "godlike" attitude which some doctors are notorious for having. He always listen to my suggestions and read any material I came across, which we'd discuss during my next office visit (I've always taken a proactive stance to my medical care). I also pointed out that if they didn't want to cover this doctor, that I would be willing to pay for the office visit out of pocket.

Although the insurance company assured me it would be only five to ten days before received a response, it was a full two weeks after their ten day limit came and went. Meanwhile, I called every day after the tenth day passed, always getting someone new, to ask if they had made a decision; explaining each time the same events over and over to whomever was unlucky enough to get my phone call. I repeatedly stressed the importance of keeping this doctor, and pointed out that I was in need of an immediate decision since I was getting low on my prescriptions.

It was always on my own initiative in calling them. Never did they ever call me. Anyway, some two weeks after their promised response deadline lapsed, I was finally advised of their decision. According to the hapless customer service representative, my request had been denied. I was told that their decision had actually been made almost a week prior but had just recently been entered into the system. How interesting I thought since each time I'd call I was told that either an email or phone message was being left with their medical review team in change of making the decision. You would think somebody would have the professionalism or common courtesy from this committee (if indeed there really is one) to either contact their own representative for a call back to me or better yet, to call me personally since I asked that my request be treated as urgent, but no.

When I asked why, I'm given a story, which in hindsight, seems a bit farfetched. Accordingly, I was told that the medical review committee designated someone to contact the doctor's office to see if they would agree to accept their insurance. As you may recall from my previous article, my doctor had carried this particular insurance for years, but effective the first of January 2015, would no longer be accepted. I was also advised that I could not pay by credit card or even by cash! Can you imagine being turned down for cash? Well, I was, and now the insurance company is telling me that I'm not allowed to pay cash or credit card for anything medical as it would constitute a "fraud". Admittedly, my first thought was disbelief. I've never been turned down for good ole American greenbacks ever. Then I was hit with the thought, could this be what people mean by the so-called Obamacare "death panels"? You are forced to accept treatment from who they approve or do without. By the same token, they can turn you down for a particular treatment and there is nothing you could do about it or any place you can go since you are "in the system" and there's no recourse beyond the appeal. As for a new doctor, I was given a choice of three---none of which have the expertise that I require. I asked if it wouldn't be cheaper to allow me to see my existing doctor than for me to see a new doctor who was not only unfamiliar with me but unfamiliar with the type of treatment I required? The end result I pointed out could be misdiagnosis, wasted office visits and fees, not to mention useless prescriptions and possible ongoing trips to an immediate care center or even emergency room...all of which they would have to pay for.

Naturally they "sympathized" with my situation, but stated that their decision was final and there was not further appeals. Since I had previously brought the matter of prescriptions, I was told that certain medicines (including one in particular that I'm taking) could be rejected no matter what it was for or how well I responded to it. To be more specific, I was told that my doctor (whomever that turns out to be) would have to call to get permission to prescribe it each time as long as there was no generic version. Otherwise, they reserved the right to decline coverage of the prescription and/or authorizing a substitute of their own choice (thus overriding the physician). Then they had the audacity to end the call by thanking me for calling and asking if I was satisfied with their responses! I admit dear reader, I've never done well with authority figures, and I tolerate even less bureaucratic simpletons setting in a cube somewhere, who has no clue who the hell I am or cares what my unique medical needs are, making decisions about me---especially my healthcare---based on their bottom line or some profit making arrangement they've made with a drug manufacturer. That just doesn't cut it with me, but there it is.

Right now, we have several local Republicans running for governor; each of whom has promised to either reform, cut back or vanquish our Obamacare based insurance system (for that matter, so are various potential and announced GOP Presidential candidates). Listen, I am absolutely the poster boy for what's wrong with my state's insurance system. It's not the hassle free system that they try to make it out to be, but at the same time, without it, we and others like us would have no coverage at all. The problem here is that it was rolled out without being fully thought through. Two years in, and there are still plenty of bugs, glitches, and administrative "Catch 22" issues, which is where I find myself.

What is needed is something more sensible like a single payer platform wherein everyone receives a basic level of coverage and then have the option of buying an additional "add on" coverage cafeteria style that fits their unique healthcare needs. This could be done either on the open market or through their employer. That way everyone gets to see at least some measure of medical care and small companies, which couldn't afford to offer insurance to their employees, could still remain competitive and those currently offering (or struggling to offer) insurance could cut back on their benefit packages without unduly affecting their employees. Another obstacle which should be removed immediately is a simple one: allow individuals to keep their existing doctors regardless of what package they have. After all, wasn't that President Obama's primary argument in selling Obamacare to the American People---that no one would lose their doctor? Or that we wouldn't lose our prescription coverage? Well, under Obamacare and at least Kentucky's version, that is proving to be a blatant boldfaced lie. Not everyone gets to keep their doctor, even if they're a specialist and no one else is available. And no, not everyone gets to keep their medication unless there's a generic substitute, otherwise, they simply don't get the medication or they're forced into taking something which may or may not work or work as well; even to the point of potentially having a negative reaction to it.

So friends, there you have it. A firsthand account of someone who has dealt with Obamacare and Kentucky's insurance exchange. For

some, perhaps even the majority of individuals, it may work. However, it remains flawed and it has been my experience thus far, that if you happen to fall into the category where you are in some way an exception to their rule, such a requiring a specific doctor, continuing with a specific doctor, or requiring a certain medication, and I would add to that requiring certain medical procedures, you're in deep trouble. The system doesn't allow for exceptions nor do the faceless bureaucrats running system seem to particularly care about your medical needs. Their sole concern seems to be about improving their bottom line, and in that quest, just maybe, is the truth about the so-called "death panels" we've all heard about. Naturally, I'm sure it's nothing personal.