Dear Mr. President, as a patient and a nurse practitioner with almost two decades of direct patient care, I can tell you why the American Health Care Act (what some call Trumpcare) failed.
Whenever you have a health care bill that wholeheartedly fails to obtain the support of numerous medical professionals, you have a problem. We are the ones literally in the trenches.
First, I will share my own personal story because it so clearly shows what my patient’s face every day.
At 39, as a single mother of three, I was diagnosed with a severe heart problem. My heart has irregular beats from the bottom of the heart. These beats, if they occur at the wrong time can result in instantaneous cardiac arrest without warning. In addition, because of the irregularities, my heart became enlarged and weak, which can result in a slow, suffocating death if not treated and controlled.
Eventually I found a specialist who offered me a procedure that could help. After the initial mass of medical bills were paid off, I still have thousands of dollars a year in cardiac testing. These tests are essential to ensure my treatments are working and determine the next treatment.
Every single year both my cardiologists spend months arguing with the insurance company to get “authorization” for these tests. However, after getting the authorization last year, the insurance company then rejected the claim.
It took 11 months to get them to pay for only part of the test.
There is a new medication available with the best data for prolonging life and quality of life. When faced with suffocating to death, this gets your attention. The medication costs over $400.00 per month.
My cardiologist thus far has gotten my particular insurance company to pay for this life saving medications for only one patient out of thousands that would benefit.
A life saving medication, that decreases hospitalizations and improves quality of life (in my case less chance of suffocating to death over months or years) and the insurance company will not pay for it.
Last year, I got a letter that my insurance company will no longer pay for my asthmatic child’s prescription inhaler. They listed no covered alternative, however.
Mr. President, you can not leave these people in charge of my healthcare. You give them all the power and they hide behind bureaucracy and paperwork to avoid providing care their members pay for. Insurance companies work for us, yet we have no say.
Then on the provider side.
As if being a patient being refused life saving tests and medications is not frustrating enough, providers face a mountain of paperwork. We have to hire entire departments to deal with the “prior authorizations” for medications and procedures. In addition, we have to document excessively and call patients back for additional visits to gather more data to appease the insurance company.
Those two things add literally millions of dollars per year in expenses to patients and providers, not insurance companies.
I could do a series every day for years giving examples of abuses by insurance companies, with their high powered lawyers that no average citizen can possibly fight.
The main reason you cannot fully leave healthcare to the “free market.”
Besides the obvious, you are putting the fox in charge of the hen house.
The goal of all companies is to make money, and they will do so at the expense of their members.
See, people like me are an expense. We are cheaper dead. By denying people like me appropriate tests and medications, we will die sooner, making room for healthy people to pay premiums for services they will never use.
You don’t believe me yet?
Where the money goes says a lot about a company’s priorities.
Stephen Hemsley is the CEO for United Health Group, one of the largest insurers in the US. Per Daily Kos, this is his pay for 2014.
“Total compensation: $66,125,208 for the year ended Dec. 31, 2014
Non-equity incentive pay: $3,949,000
Other compensation: $107,479
Exercised stock options: $45,569,049
Value realized on vesting shares: $15,199,680
New stock options: 83,918”
In 2010, he earned a total of $102 MILLION, which included a $66 MILLION dollar BONUS.
United Healthcare is one of the companies advocating for rate increases in 2017.
How many lifesaving medications could Hemsley’s $66 million bonus pay for alone?
THIS, Mr. President, is just one of 102 million reasons why insurance companies cannot be left in charge of our healthcare.
You must do better.
You have a once-in-a-lifetime chance to really change the world and improve the lives of your fellow Americans. Allowing health insurance companies to shift the costs to members, while denying medications and services and giving themselves obscene bonuses serves no one but overpaid CEOs.
I save lives for a living, and my lifetime earnings will never equal the bonus of what this ONE CEO earned for denying patients care.
This is why you must do better; Congress must do better. Mr. President, you must meet with people providing direct patient care to fully understand the issues. Nurses, Nurse Practitioners, Physician Assistants, and Doctors who are currently active in practice will give you the solutions you need. Mr. President, you must find a way.
If you fail, it will not be forgotten.
What do you think? Can the President repeal and replace Obamacare with Trumpcare? Will it work? Let us know in the comments, and in addition, share this on social media!