Justices appear split on HMO issue (Check out Scalia's comments)

[coda]

Many people suggest that a national healthcare system would mean inflexible, one-size-fits-all healthcare, but with these HMO's attitude toward healthcare, many patients already experience it and probably say, :shrug: "We already have that."

Story has quotes from O'Connor and Stevens, as well.



Justices appear split on HMO issue
Patients want state court, larger awards
From Bill Mears
CNN
Wednesday, March 24, 2004 Posted: 3:58 AM EST (0858 GMT)


WASHINGTON (CNN) -- A patient whose hospital stay was cut short and a man forced to take a cheaper prescription drug want their day in court to prove their malpractice lawsuits. The question Tuesday before the Supreme Court was: Just which court should decide the matter?

After oral arguments, the justices appeared split on the issue.


<snip>

"All we're talking about is money," said Justice Antonin Scalia. "All the HMO said was, 'Under the plan ... we don't have to pay for Vioxx, and if you want Vioxx buy it yourself.' All this company was doing was looking at the contract, and saying, 'Do we owe any money?'"


Actually, all he's talking about is money, others are talking about people's lives.

If you were talking about people's lives it would go something like,

"All the HMO said was, 'Under the plan ... we only have to pay for the drug that makes your stomach bleed, and if you don't want your stomach to bleed OR arthritis, to bad.' All this company was doing was looking at the contract, and saying, 'Do we owe anything resembling a quality of healthcare, as prescribed (or demanded) by our own accredited physicians?



more.....

http://www.cnn.com/2004/LAW/03/24/hmos/

[The Backlash Cometh]

1. HMO plans are a prescription for disaster.

They are too inflexible. I myself got caught in the web and lost ten good health years because of it. The company from which I derived my benefits, kept changing plans every year for three years and I eventually lost the right to see my regular doctor. I then went to a doctor who was of Indian extraction. He prescribed a medication which required two weeks usage. It was a heavy anti-biotic and by the fifth day I was in tremendous pain and I called the doctor's office. I was told, by him, that I had to take it for two weeks. I called again on several occasions because the pain escalated, but was told the same thing. By the ninth day, I collapsed.

From that point on I was caught in an HMO twilight zone where each doctor misdiagnosed and then prescribed treatments which either did nothing for the condition, or made it worse. I got to see, first hand, everything that was wrong with the HMO system. One of the problems was that the doctors were hostile to HMO patients. One doctor even told me that seeing HMO patients took time away from his regular patients. I told him I thought I was a regular patient.

We finally moved away from the place and I found a decent doctor who told me that my condition was induced by the anti-biotics. He said that the prescription was far too strong for me and that it killed the flora in my stomach, and that patients have been known to die from that condition.

But could I sue the HMO and the doctor? No. It wasn't allowed at the time. I just lived a living hell for ten years as my system recovered.

The lesson in all this was provided by my new doctor. "Why didn't you just stop taking the prescription?" My answer: Because up to that time, I believed that doctors were professional and that they could do no wrong.

But since then, I question everyone's decisions. I don't care who they are or what position they hold.

[Disturbed]

2. Scalia

He is a Theocratic Fascist who should be impeached.

[coda]

3. Geez, that hits pretty close to home for me.

I had one of those "bug" ulcers (heliobactor? sp) and I hadn't had any antibiotics for years. I was given a "moderate" type of antibiotic that actually worked pretty well, but it also killed too many bugs the digestive tract. Not good. I had some problems a year and a half later that included infection and was given a really hot antibiotic dose for 5 days.

You're aren't kidding about problems with killing ALL the flora! It was months before things began to straighten out. The last (fifth) Dr. I had solved the main problem I was having and in telling about my previous experience(s), I told him I would have to get really bad before I would do the anti-biotic thing again.

He was the one that gave me good explanation of what you're talking about(flora) and I asked him why they didn't have something like the equivlalent of Rid-X for septic tanks, to replace those "bugs". He said shruged and said it sounded like a good idea.

It's possible there is something out there, but if not it should be researched. It could have made months of difference for me. Your experience sounds exactly where I was afraid I was heading.

God TBC, ten years? I hope you finally recovered completely.

[The Backlash Cometh]

4. The suspicious part of all this is that there were anti-biotics on the

market that could have handled my condition without the horrible side-effects. So, why did the doctor insist I take the horse pill? Were his hands tied because I was on an HMO?

And, no, I can't say I fully recovered. I'm still afraid to land a full time job because the medical experience triggered a hypo-glycemic condition which I was probably pre-disposed for, but wouldn't have had to deal with for another thirty years. So my money making, productive years are being squandered.

However, I've forced myself to move on and I'm working hard to do what I have to do to get back into fighting form. I've probably felt "back to normal" more so in the last two months than I have in the last ten years so I see promising improvement.

[salin]

5. For what it is worth

You have my sympathy, support, and steadfast rooting for prolonged stabilized health and stamina (yours is too fine a mind, and too clear a soul, and too strong a voice to be impeded... we (collectively as a society) need you.)

I would guess that compounding all of the health problems, is the complete shaken faith in the systems that we believe keep us protected - and to know that they were the origins in a completely avoidable scenario - that kind of reality/realization can have its own ongoing effects.

In a different scenario a misdiagnosis of complications after a surgery, I believe, led to a premature death (maybe by a few or more years) of my father. Too many steps and "maybes" to make a case - and it involved a slow growing cancer - so we still had time together - so it was never pursued. But the thing is, had it come to that - due to being covered by regular insurance - we might have been able to pursue it. The insidious thing with this current situation is that the HMOs MAKE medical decisions with their approval, denials, and "guidelines" for prescriptions and other care by their doctors - but that they are shielded from legal actions of real damage caused by those decisions. Scalia's response is ludicrous. If we all had the money to buy the prescriptions we might need - then there is no purpose for insurance to begin with.

[The Backlash Cometh]

6. My sympathy on the experience you had with your father.

I agree fully with your assessment of HMOs. I think the quick and/or incompetent way they diagnose patients is certainly hurting people. But because the system doesn't hold them accountable, nothing is going to change. And I believe that the suffering they inflict will broaden to the wider population once tort reform becomes law and this non-accountability extends to PPOs and other private doctors.

And I thank you for your kind words. God works in mysterious ways, they say. If nothing else, the last ten years have slowed me down enough to give me the time to observe what has been happening in the world and in our country. While everybody else hustled off to work, I have had time to see, listen and examine the trends that have been unfolding. An arm-chair news junkie by force, but a social commentator by choice.