Tuesday, July 22, 2008

Pattern of Corruption

Tuesday's Tirade

Telling stories can be powerful. Stories of the challenge of maneuvering through a health care system that many times places profits above the care of the subscribers. Stories of intimidation. Of stigma and denial.

Yes, telling stories can be very effective. Sometimes. Yet stories do very little to change minds if they fall on deaf ears.

On May 30, 1996, Dr. Linda Peeno, Medical Director and claims reviewer for health insurance giant Humana, told her heart wrenching story to the United States Congress. The lengthy testimony has been described by many as "The Confession of a Managed Care (HMO) Medical Director."

On June 21, 2007, DemocracyNow.org described Peeno's historical appearance: "A decade ago Dr. Linda Peeno made headlines when she told Congress about her work as a medical reviewer for the giant HMO Humana, where she says she denied a man life-saving medical care in order to boost company profits. She would go on to become one of the country’s best known whistleblowers about HMOs and the healthcare industry."

Peeno's testimony before Congress was, and still is, an indictment of our health care system: As reported to Congress in 1996, Peeno disclosed, "I am here primarily today to make a public confession. In the spring of 1987, as a physician, I denied a man a necessary operation that would have saved his life and thus caused his death. No person and no group has held me accountable for this, because, in fact, what I did was I saved a company a half a million dollars for this."

Shockingly Dr. Peeno's expert story did little to change the minds of Congress. The extent of the “damaged care” Peeno described left little impression. Why? That I would like to know. Me and thousands of others who have been denied their rightful benefits by health plans. This systemic problem knows no bounds.

It was September 3rd of last year when National Public Radio, All Things Considered, filed a report on the significance of Peeno's appearance before Congress ten years earlier. http://www.freewebs.com/courageoffaith/%27Sicko%27s%27%20Peeno%20Sees%20Few%20Gains%20in%20Health%20Insurance%20%20NPR.mht

Sadly, the abuses continue. Sadly health insurance officers are brashly denying what too many people know to be true.

In 2007, Humana's Tom Noland challenged Dr. Peeno's assessment. NPR reported that Noland stated that the “story is too old to still be a valid snapshot of the health insurance industry in general and Humana in particular...The system has changed completely in 20 years, and it's changed, frankly, in response to consumer demands and needs. In the '90s, there was a tremendous amount of frustration because health plans were by-and-large in the business of saying no. Now, they're in the business of saying yes."

How brazen! Well, Mr. Nolan. You've done it again. As I learned with Carelink Health Plans, Inc. of West Virginia, oftentimes facts are not accurate. Frustration remains. In response to today's consumers demands, your statements will be proved laughable.

Today, however, I am not laughing.

Tuesday's Tale

He’s Dead and He Killed Five More

In February of this year former graduate student Stephen Kazmierczak killed himself. After killing 5 others and wounding 15 people at Northern Illinois University.

The story is told of an excellent student who went berserk, attributed to his not taking his medications as needed for a mental health issue. I wish this were the case.

This may be an overly simplistic picture I paint, but it is what I have experienced in my lifetime. The mentally ill, I believe, are among the poorest of our poor. Without insurance, they cannot receive the quality care they desperately need. With insurance, they may not receive quality care they desperately need. I know of two instances locally where such care was denied the mentally ill even though the psychiatrist had stated it was warranted.

I have no way of knowing if Kazmierczak was ever denied therapy by his health plan, or if he even had a health plan. What I do know is what I read.

There is too much violence linked to mental illness. http://www.freewebs.com/courageoffaith/Illinois%20college%20shooter%20stopped%20medication%20police%20%20U_S_%20%20Reuters.mht

Many mentally ill can recover from debilitating symptoms to become vital members in society. Without the medical attention, violence happens.

I know. I know of the ruthlessness of a health plan that denied a subscriber of medically necessary surgery and wrongly accused that mentally ill person of fraud in an attempt to terminate him. I know. Now, many more know this too.

There is likely more to this story.

No comments: