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Bake Sale for Health Care

Posted 10/25/2011

Pretty much every weekend I head to my cabin in rural Illinois for some R&R. At some point, like any reasonable city person, I grow a tad bored with the clean air, wildlife, and all those trees and head into one of the many small towns in the area to compare main streets, sadly bereft of bustle with their resale shops, tattoo parlors, and boarded-up shop windows.

When I actually go into a store, I usually see something at the checkout register that I never see in the big city: a color copy of a handmade poster featuring a photograph and a plea to donate money.

The posters are heartbreaking variations on a single theme.

“Billy Johnson, 12, from Middletown was struck with an unusual form of leukemia (…or bone cancer or brain tumor). His single mom, Mary, is in danger of losing her night job at the Wal-Mart because she spends so much time caring for Billy and driving him to doctors for his chemotherapy. She may lose her home because of mounting medical expenses…”

Taped to the poster of a child (almost always frail, frequently bald, and with sad sunken eyes) is an empty plastic margarine container with a hole cut into the lid for sympathetic shoppers to leave some change or maybe a bill or two. I asked a clerk if I could peek at what had been collected in one such container: $4.34 for the week.

Visit another town and it’s a different homemade poster, a different Billy, maybe this time an Amanda. The story’s largely the same in every case, though, and often after a few weeks Billy’s poster and collection tub are replaced with a new one. Maybe a young mother with breast cancer, a premature baby fighting for his life, the local librarian with end-stage diabetes.

In small-town Illinois I see more of these posters than I do the plastic-flowers-and-cross roadside shrines on two-lane blacktops, placed to commemorate someone’s fatal road crash. Keep in mind the people who will say a prayer of thanks for the coins in their margarine tubs are not victims of road crashes. They’re still living, though their lives are difficult for many of us to imagine.

By the way, the one place you’ll never see these poster/donation boxes is in the checkout line at a Wal-Mart. Could this have something to do with the announcement last week that the chain will stop offering health insurance to new US part-timers working fewer than 24 hours weekly and that it will cut by 50% its contribution to employee health expense accounts (used to pay medical bills not covered under their plan)?

Back to the cash register…and a fundraiser
Sometimes instead of the collection tub there’s an announcement of an actual fundraiser, usually a bake sale but occasionally an evening party with an ersatz rock band for entertainment. These are held in church basements or down-at-the-heels American Legion halls.

I went to one of these fundraisers recently. Middle-aged women sat behind tables laden with paper plates holding cookies and cupcakes. Some sold hand-crafts like crocheted bookmarks, needlepoint–you know the selection. I guessed they’d raise about $40 tops for the evening, even though I left with a handful of bookmarks (you can never have too many crocheted bookmarks) and a plate of smiley-face cookies.

In yet another town, the poster announces a memorial, the local Billy having died and his mom now virtually bankrupt.

I think about my own comfortable life, kids secure, the ability to fall back onto my fairly good health insurance in a crisis, and I try to imagine what it must be like to be Mary, alone in her dark bedroom at night, numb with exhaustion from a long shift at Wal-Mart, reviewing Billy’s medical bills, food shopping, meal prep, pharmacy, house a mess but nobody’s coming over anyway, lying there thinking about her son in the next room with his cancer. She’s wondering about their futures and she’s really, really frightened. Not only of her son’s almost certain death but also—and she berates herself for this—about the impending bankruptcy that will shatter her fragile hold on her world.

She’s not poor enough for Medicaid, but that likely wouldn’t help anyway. Illinois is so far behind in its payments that most specialists won’t accept Medicaid.

The American Cancer Society recently reported that more than one-third of the people under 65 diagnosed with cancer are uninsured, and that 75% of this group have lost their insurance because of high premiums or a pre-existing condition exclusion.

Mary’s pay at Wal-Mart is a couple dollars above minimum wage, but medical expenses on her high-deductible policy eat up a full 20% of her gross income (that’s $4000 of the $20,000 she earns). As you might guess, a cancer diagnosis is the single greatest risk for bankruptcy. If Wal-Mart lets her go because she spends too much time with her son, she’d be eligible for Medicaid, but she’d likely lose Billy’s oncologist, who wants to get paid himself.

Light-years away, on the other end of the healthcare universe (and the distance is at least that far) and requiring no bake sales whatsoever, the five largest for-profit health insurers netted $11.7 billion in profits in 2010, up 51% from 2008 profits, attributable primarily to a combination of premium increases and the fact that insured patients skimped on medical care to avoid costly co-pays and deductibles.

As a reward for these record profits, the CEOs of the five largest companies garnered $54.4 million in compensation in 2010. That’s right: five CEOs, $54.4 million, the champ being Cigna’s David Cordani at $15.2 million. Meanwhile, the industry’s lobbying group, America’s Health Insurance Plans (AHIP), funneled $86.2 million into the US Chamber of Commerce in 2009 with the goal of weakening or even eliminating the Health Care Reform Bill, even though in its existing form they will profit mightily from it.

What keeps these CEOs awake at night is the public option possibility sometime in the future, so-called Medicare For All or single-payer care.

These days, in addition to the big money from premium increases, more wealth for the insurers comes from a combination of simply not paying claims plus cherry-picking healthy enrollees with no pre-existing conditions. To quote the CEO of WellPoint, “we will not sacrifice profitability for membership increases.”

The insurers are using any tactic imaginable to shift the cost burden onto the enrollee (that would be you).

According to the AMA, every fifth claim (19.3%) submitted to a for-profit insurer is incorrectly processed by them to deliberately delay payment long enough that the patient herself will be billed for a service that should have been paid by her policy. (By comparison, Medicare has an error rate of 3.8%.) Physicians received no payment whatsoever on 23% of the claims they submitted to commercial health insurers.

These figures come via Physicians for a National Health Program (click for some stimulating reading), which defines itself simply. They’re a non-profit research and education organization of 18,000 physicians, medical students, and health professionals who support single-payer national health insurance (yes, I’m a member).

As Mary and Billy face the twin challenges of cancer and financial meltdown, so too will some Frank, Catherine, Jose, Maria, and thousands and thousands of other poster faces across the country. I’m sure they’d all be grateful if you’d toss your change into that empty Country Crock container at checkout or splurge on a plate of cookies.

But I think we’ve got to consider doing something more.

Be well,

David Edelberg, MD 


Leave a Comment

  1. Rob says:

    This is more frustration that we can protest at the Occupy (insert local major park name here). The practical option I have is to vote with my dollars by trying to stay healthy and avoid going to hospitals. That does not fix the problem. It seems that this problem is way beyond anything I have control over. I am not sure what we can do here. Insurance companies suck!

  2. Sue Zilberstein says:

    This article touched me so deeply. I am a British physician now living in Chicago.

    I have had first hand experience of what you say about the insurance companies. Like Dr Edelberg, I have been fortunate.I would love to volunteer my time and skills to help those in need sort out their insurance issues. If anyone knows of a way I can do this, please email me at drsue@strikeabalance.org

  3. Mark S. says:

    Thanks. I just scanned Physicians for a National Health Program. Seems like real heath care took a dive in the early ’80’s when the United States declared it to be a business, for profit. Hospitals became for-profit corporations, doctors and dentists began to advertise and sell competitively. Now one can buy health treatment but very few offer actual health care. Of course, that treatment is cash in advance – validated insurance. The system seems to be set up to drive as many people as possible to near death, then bring them in for dramatic “life-saving” treatments. After all, that’s where the money is. The caps come off the charges (under something called DRGs?). The sky is the limit, although somehow the institutions radically cut back their heroic efforts when the patient’s bank account and insurance are about to be depleted.

  4. Sharon Rukin says:

    Thank you for posting this… I am passing this along so others have access to this very important perspective.

  5. francine says:

    Got a far as Walmart not giving PT employees as many benefits as they had…my son has worked for a number of companies up to 35 hours a week & gotten nothing, heck, had I known Walmart offered coverage for folks working 24 hours, I’d be there just for the benefit! Apparently there is a reason people work there, they are WORKING! They have the choice to go elsewhere & get zero benefits.

    Walmart partially pays for medical expenses not covered by the insurance plan? How tremendous, but you are complaining they are not paying enough? I get nothing! Why does this “give me more” mentality exist? If one is not happy with current conditions, find better elsewhere. Why is it a businesses business to provide everything for their employees?

    You hooked the reader in by beginning with the plea for donations for a sick child, mentioned you yourself live comfortably, & the CEO’s make way too much. My I suggest you have your current life style because government did not mandate what you could earn/be reimbursed? You do not accept Medicare as I learned when I attempted to bring my mother in. Why is that, I wonder? Could it be that reimbursement rates are so abysmally low with Medicare, our govt regulated system, that you choose to only accept those with private insurance or self payors? Many physicians will not accept Medicare patients, enrollment in medical universities is falling, how does a govt run system encourage better service, training and care, when the poorest graduating doctor is “entitled” to nothing better than the one who graduated top of the class? Food for thought.

    Ordinarily, even though my mom is not able to benefit from what I believe is excellent care with your practice, I very much enjoy your blog, today however, I could have done with out.

  6. Kate Maver says:

    I am involved with the Gesundheit Institute–Patch Adams’ organization–and they are trying to do something about this. Not only do they support single payer, but they are also working to help health care students learn about compassionate, loving care. John Glick, MD, says this in one of his articles on the patchadams.org website: “The corporatization of healthcare has created a system which is not primarily about care (it’s about management) and it’s certainly not about health (it’s about disease). Disease management relies on efficiency, and can be dehumanizing. People become barcodes. McMedicine exploits human suffering by squeezing the possible penny of profit out of our sick and injured brothers, sisters, children, mothers and fathers. Hand in glove with the economic system of healthcare delivery is the medical technologic industry. Its advances and excellence are unquestionable, but technologies are costly. While technologies advance the reach and accuracy of diagnosis and treatment, they also, due to the high costs involved, result in rationing of healthcare, and a disturbing tendency to further reduce the scope of medical inquiry to those findings that the technologies are designed to reveal. The patient’s personhood is obscured or lost altogether.
    The medical-industrial complex is geared towards profitability, and it is phenomenally successful at this. Meanwhile, patients are problems, one per visit, and care givers are cogs in the machine. Physicians are referred to as “providers”, “gatekeepers” feeding the maw of McMedicine to generate as much profit as can be afforded and more. The system is paternalistic, manipulative, exploitative, dysfunctional and unhealthy . . . Perhaps the current in healthcare can shift from the narrowly focused individualistic, profit-obsessed morass that we have now, to a community centered, compassionate way to care for others. In the meantime, perhaps we can seed our profession with loving care givers, and slowly, one by one, help our patients and colleagues to awaken from this collective madness causing us to fear, exploit and hate one another.” http://www.patchadams.org/pedagogy-of-love

  7. Lynn says:

    I am a bit surprised Dr. Edelberg. For someone who supports a National Health Programs with such enthusiasm as yourself for the unisured, I would expect that medicare, despite privatization of some aspects of it, would be accepted in your office. Despite the fact that for the 65 and over age group, it would cover some of the lab work that you do, physical therapy services and possibly chiropractic services, it is NOT accepted.

  8. Martina Swanson says:

    This is a heartbreaking article. What comes to mind beside the anger of injustice, where a few individuals enjoy plush life on sick citizens back, is all the foreign aid flowing out of our country to help desperate citizens of OTHER countries! It is my tax money sent where ever around the world without my consent. What about our own?? This commentary and last week’s posting of a very poor dental care in many areas of this great country saddened me very much.

  9. Dr E says:

    I have answered the Medicare issue before and will be happy to do so again. I accepted Medicare for many years until I was audited by them and told straight up front that I was spending too much time with each patient. Unraveling the lifetime issues of, for example, a patient with fibromyalgia, can take well over an hour. The Medicare auditor said “My supervisor says anyone can diagnose fibro in ten minutes tops. He thinks you must be talking about the Cubs.” Medicare can then demand something called a ‘retroactive refund,” asking for all the money back they have paid you. This can go back for years and obviously come to thousands and thousands of dollars.
    An attitude like that is totally counter to the philosophy of holistic medicine, dealing with the “whole” patient. Hence, I was reluctantly compelled to leave Medicare.
    Actually, Medicare’s reimbursement rates are so close to those of Blue Cross that if their attitude were better, I’d have no problem with it. at all

  10. Addie says:

    There is a spiritual element to the stores’ small charity containers. Based solely on my own experience, I believe many religious people believe it’s not possible to solve this kind of problem. They leave it to “G-d.” as it were, and contribute to make themselves feel better. This attitude appears to spring from the notion that we’re sinful, fallen creatures, doomed to suffer. If you listen carefully to the religious Right, you’ll pick up this inference repeatedly. Assuming the social responsibility necessary to deal with these issues requires a can-do, positive spiritual outlook, an impossibility for those who believe in a heavenly mandate for suffering, pain and death.

  11. Rasa says:

    That is a heartbreaking story. The Occupy Wall Street movement is a very nebulous protest but this sort of information about the disparity and downright unethical practices of businesses is what I think they are trying to bring light to.

    Thanks Dr. Edelberg for another great story.

  12. Imran says:

    Dr E, another great newsletter connecting the influence politics, or more precisely, money and the profit motive play in healthcare. How can a system which makes more as people get more sick be a viable system for a society? Other than increasing that number called GDP (as each Billy is diagnosed with a highly profitable disease), I see no benefit for the average person. Sickness is profitable in a market based system. Until we can collectively realize that this system is a failure for many, we will not see the alternatives. Of course, you have people who are privileged and don’t ever have to deal with Mary’s situation and because of that they can go on living without raising a single protest. We need to look beyond our privilege at what is really going on in this country. Eventually, it will get the rest of the 99%…

    “Politics is the shadow cast on society by big business… the attenuation of the shadow will not change the substance.” – John Dewey

  13. Dr.E: WBEZ (91.5 fm; NPR–although I’m sure you’re a listener) this a.m. had tragic stories of families w/kids w/mental health problems and no help) got me to thinking I should join the Occupy protestors. Your newsletter reinforced the thought. Thank you.

  14. Ann Raven says:

    Some people are realizing and mobilizing and, if we care, we can support them and even join them! There was a old film called Network in which the protagonist shouts “I’m mad as hell and I’m not gonna take it anymore”! Many of us are at this point.

  15. Judy Kayser says:

    I live in rural IL and also see these same type of posters and contribution containers all the time. It is heartbreaking to realize how hopeless these people must feel. It is shameful that people in the US, usually those that have health ins., seem to accept this as just the way it is.

  16. Bob Gosdick says:

    As a retired lawyer having had a second office in a small Northern Ill. community, I can attest to the fact that these fund raisers have taken place for many years – and are increasing in frequency. Not once have I heard of anyone misapplying the funds collected, but have seen the thankful tears in the eyes of the recipients.

  17. Kathleen Walsh RN says:

    Thanks for this; I called once to speak with someone in your office re: my work with Jan Schakowsky re: the disparities/inequities CDC report of Jan 2011 and our efforts to raise consciousness and citizen energy re: the complex problems in health care. I’m a member of PNHP and am pleased to see your enthusiasm and that you are a member for improving health care options for all. Be well, and we carry on

  18. Mery Krause says:

    Well stated, Dr. E. I’m sending this to everyone on my email list, whether they want to hear it or not. Something has to change in this country, and I hope it does before I’m bed ridden in some hospital or nursing home, since I don’t have any children to take care of me – not that they would want to anyway, and that’s just why we didn’t have any.

  19. Thom Goetz says:

    Hear Hear. I have been reading “The Innovators Prescription (A Disruptive Solution for Healthcare) by Clayton M. Christensen. An excellent book for possible change in our system. A must read

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