Richmond Beach On A January Morning

Health Care Costs Will Bankrupt the Nation

Below is a story from the Seattle Times columnist Danny Westneat. It is a very descriptive account of what is wrong with the American health care system. You get plenty of care and it's generally very good. But how much it costs and who pays, is another story.

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The sting of a broken system

By Danny Westneat

Seattle Times staff columnist

In what world can the word "in" mean "out?" And the number "one" actually mean "two," at least when it comes time to pay your bill?

In American health care.

Where Keo Capestany has learned the hard way, strange math can mean a bee sting will cost you eight thousand bucks.

"I have to warn you, this is a pretty ridiculous story," Capestany said when he introduced himself the other day.

It started last August, when Capestany, a Seattle 73-year-old, was at a picnic and plopped a slice of steak in his mouth.

A yellow jacket was clinging to the bottom side. It stung or bit him right on the tongue.

Capestany is not allergic to bees. But over the course of the next 24 hours, his tongue swelled so much he worried it might choke him.

He drove to Seattle's Harborview Medical Center. After a few hours' wait, he was put on an IV drip with the antihistamine Benadryl, placed in a bed and admitted to a hospital room.

Or so he thought he was admitted.

He was there for the rest of that day and night. He ate lunch, dinner and breakfast. He continued to get antihistamine through the IV.

"I felt I got good medical care," Capestany recalls. "The doctors wanted to make sure I was OK. By the morning it was clear I was, so they sent me home."

Two weeks later, though, he got stung again: The bill was $8,200. The IV costs alone were $2,469. The emergency room fee: $2,822. The pharmacy tab ran to $964.

He also had room charges for two days, Aug. 4 and 5, totaling $1,488. Even though he was there only one night.

Eight grand seems pretty steep for a bee-stung tongue. It's far more than Harborview's Web site says it charges for everything from a broken arm ($262) to a colonoscopy with removal of a tumor ($1,796.)

But the story went further down a rabbit hole next.

Capestany found out that though he spent about 22 hours there in a room, his treatment is considered "outpatient."

His insurance (Medicare Part A and his wife's policy) only give broad coverage for inpatient hospitalizations, not outpatient visits.

"Your records show that although your tongue and neck were swollen, you denied any respiratory distress in the Emergency Department," Harborview officials wrote after Capestany appealed his bill.

"Your respiration was stable at 16/minute, your other vital signs were stable and your airway was not compromised. To be considered inpatient status, you would have to have some airway compromise and a respiratory rate greater than 24."

Translation: He wasn't sick enough to be "in." Yet he was too hurt to be "out." So they put him kind of sort of "in." Leaving only his money to go "out."

"For the purposes of my insurance, I never stayed there. For the purposes of my bill, I stayed for two days!" Capestany says.

Have I mentioned that Capestany worked 25 years as an insurance adjuster? He's not some naïf about how this stuff works. Or doesn't.

He's not saying Harborview or Medicare has done something illegal. Harborview couldn't discuss Capestany's bill with me, but said it's Medicare that sets the rules on whether someone is an inpatient or out.

In fact, Medicare puts out a six-page guide — with charts — on how to tell which is which. It's so complicated, they advise that if you're ever in a hospital for more than a few hours, you better ask about your status. I wonder: Would staff even know the answer?

Capestany's story is a microcosm of a broken system. Outrageous costs. Bills with little relation to the services provided. Rules too complex or hidden to be of any use to distraught patients.

We used to be debating how to fix these things. Now it's whether health-care reform is even worthwhile for Congress to consider.

Meanwhile, medical spending rose faster in 2009 as a share of the economy than at any time since the issue was first tracked in 1960.

I sure don't know what would work. A single-payer system, competing insurance exchanges, health savings accounts — all seem better than what we have now.

Yet some say no, slow down. Leave health care until we repair the economy.

At $8,200 for a bee sting, health care could become all that's left of the economy.

Obama Shines

President Obama met with House republican leadership in Baltimore yesterday taking questions from a hostile crowd. He was quite impressive with his intelligent, knowledgeable responses to questions that sometimes weren't so intelligent. Of course, that may be exactly why some dislike him: he's just too smart. Like Bill Clinton.

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Obama And Reagan

January 27, 2010, 6:27 AM

Same As He Ever Was

Paul Krugman

These days quite a few people are frustrated with President Obama’s failure to challenge conservative ideology. The spending freeze — about which the best thing you can say in its favor is that it’s a transparently cynical PR stunt — has, for many, been the final straw: rhetorically, it’s a complete concession to Reaganism.

But why should we be surprised? Here’s one from the vault. Two years ago, I was deeply frustrated with Obama’s apparent endorsement of the Reagan myth.

There was a lot of delusion among progressives who convinced themselves, in the face of clear evidence to the contrary, that Obama was a strong champion of their values. He wasn’t and isn’t.

That doesn’t mean that there’s no difference between the parties, that everything would have been the same if McCain had won. But progressives are in the process of losing a big chance to change the narrative, and that’s largely because they have a leader who never had any inclination to do so.

Make School Buses Green

Washington State legislature is considering a 'green makeover' of schools. The school buildings would become more energy-efficient, thousands of jobs would be created locally, and we'd save money in the long run. Washington unemployment is officially 9.5% (the real rate is much higher), so it would be good to get more jobs - even if temporary - especially in construction where we've lost so many jobs lately.

I think that we should start the 'green makeover' of schools by updating the school buses first. Have you ever driven behind a school bus? They are the nastiest things on the road! The pollution emitted from just one bus is overwhelming. Has anyone ever looked into that?

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Haiti

(Image from The Seattle Times)

The devastation in Haiti is very upsetting. A nation so poor they don't have the machinery to dig up dead bodies from the rubble. No food or clean water for days because the help cannot arrive? It s shameful that such a poor nation exists on the doorstep of the most powerful, rich nation. Perhaps Obama will do the right thing and help change US policies toward Haiti? Policies that will support self-reliance, not dependence?

Carl Lindskoog's article explains, at least partially, why the country is so vulnerable.

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Why I Don't Trust Obama

Matt Taibbi and RFK Jr. on Obama's Sellout to Wall Street

Matt Taibbi and Robert F. Kennedy Jr. discuss Obama's ties to Wall Street. It burns me that we have thrown so much money to banks that have utterly failed the nation and its people (and the world). Yet our "progressive" president seems to take their side on every issue. I cannot finish Obama's book "Dreams from My Father" (although recommended by my mother - and I read most everything she recommends), because I am so disillusioned by him. Not that I was ever quite comfortable with his quick rise to the top; but I wanted to believe, to give him a chance. And, compared to the previous president, everyone is a superstar.

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