AOC nailed it.

[634-5789]

[questionseverything]

1. Insurance companies are scammers that produce nothing

May the execs and those that defend them rot in hell

[BlancheSplanchnik]

17. 👏🏽

[grantcart]

25. It was a Medicare recipient (according to a reply down thread)

[questionseverything]

33. I don't care if it's medicare

Or the prescription supplement plan or some hospital group

All of them have thousands of people making big bucks to deny care for us

I stand by my original statement

[TryLogic]

47. I think Medicare drug coverage is administered by insurance companies.

Not sure how that all works. I refuse to buy drug coverage -- so far. May be a big mistake although this example seems to suggest otherwise.

[TexasBushwhacker]

61. If you don't sign up for drug coverage when you begin getting Medicare

you will pay a monthly penalty when you do decide to get it.

[flying_wahini]

86. And the penalty continues year after year, they never let you back in at the base rate.

You have to have it and they know it.

[grantcart]

57. Since 2013 with Sen Al Fraken's brilliant cap on medical loss ratio amendment

to the Affordable Care Act not one penny has been added to a single health insurance profit, dividend, executive salary, or executive bonus as a result of denial of care.

The gross margin in health insurance is called The Medical Loss Ratio. The MLR is set at either 15% or 20% of gross sales and has nothing to do with direct costs, I.e. payments on medical expense claims.

If an insurance company spends less than the 80% (or 85%) of the total sales figure then the underpayment is refunded to customers. Two months ago I received $400 from my insurance company Ambetter for 2019 under payment.

Your charge, which was true prior to 2013, is no longer true although the charge has been repeated by Sen. Sanders continuously and one time by Senator Warren in a debate.

It has resulted in billions returned to clients.

Your sentiment which is understandable is simply no longer factually accurate.

What is the point of passing great legislation if the charges which were true but no longer are relevant are continually re asserted? This is what creates the nihilistic angst that nothing ever improves, which is not true.

The Medical Loss Ratio controls insurance profits and executive compensation. It is calculated by a fixed margin on sales and is not affected by denial of claims, period.

[Metatron]

90. Great post

It really deserves to be its own thread for more exposure and to remind people of why we fought for the ACA.

[Blue Owl]

2. K&R for visibility

[spooky3]

3. the true "death panels" (remember that term from the anti-Obamacarers?) are insurance

committees like this one.

[SWBTATTReg]

4. They should have blasted this insurance company's name all over the media...this is despicable...

[birdographer]

10. Exactly

Why is this not being broadcast? Innocent people are signing up with that company with no idea of their policies.

[George II]

27. Because it's NOT an insurance company.

[tulipsandroses]

5. Shameful. I had to look this up to see if this was true. It is

She managed to raise the money they said she needed for the immunosuppressive medications.

[cwydro]

13. Which insurance company is it?

[Celerity]

22. Spectrum Healthcare was the firm denying it (and she had Medicare)

https://www.democraticunderground.com/100214637945#post19

[tulipsandroses]

24. I don't know who the insurance company is. The letter was sent from the health care provider.

Spectrum Health. It wasn't sent from the insurance company.

[AllaN01Bear]

6. here are your death panels .

[diva77]

7. All those wingnuts with their phony religious beliefs enable insurance companies to play god

[WyattKansas]

95. The Bible Thumpers need to be constantly grilled about 'What would Jesus think of our...

Wealth Care System in place for our health care?'

When they start to stammer, follow with the comment, 'I'm sure Mammon very much approves.'

Then closed out with the question, 'And who exactly are you pushing again?'

That is the very bottom line for all of the almighty Capitalism is the best ever bullshit and Republican forced Mammon worship health care in the United States of America. And there are NO fucking arguments that ever justify that!

[DeminPennswoods]

8. The Sunday Pgh Post-Gazette had a big

story on just how many people are using GoFundMe campaigns to cover medical bills. It's ridiculous and infuriating.

[George II]

9. Two years ago? Are there more details about this insurance company, "the committee"....

....and the circumstances? And where is GoFundMe mentioned?

Thanks.

[cwydro]

14. Good question.

Why is the insurance company not named?

[diva77]

20. according to the ph number shown -- it is Spectrum Health

[George II]

29. Ah, so much for "Insurance groups recommending GoFundMe as official policy" eh? In fact they didn't.

[diva77]

31. That's just the ph no. for the transplant office. I don't know anything about it and I wouldn't

be so quick to defend insurance companies -- considering what Wendell Potter, whistleblower, has been saying for years.

http://content.time.com/time/politics/article/0,8599,1920893,00.html

[George II]

42. But the tweet claims "Insurance groups recommending GoFundMe as official policy"....

....which is inaccurate.

[radius777]

56. "The Committee is recommending a fundraising effort

of $10,000."

They didn't cite the GoFundMe platform specifically but that is what most people would use to fundraise.

[George II]

58. Again - "Insurance groups recommending GoFundMe as official policy". There's no basis in fact there.

[Cuthbert Allgood]

87. Seems like an odd topic to punch left on.

Though not unsurprising.

[George II]

89. Truth isn't an "odd topic".

[radius777]

96. There's a difference between literalism and truth.

AOC speaks to the truth of how it would play out in practice.

[George II]

97. Yes there is, and truth is much more important than literalism.

[Celerity]

19. Hedda Martin Heart Transplant

Spectrum Health transplant patient Hedda Martin raises $30K

https://eu.freep.com/story/news/health/2018/11/30/hedda-martin-spectrum-health-transplant/2162187002/

A Grand Rapids woman is back in line for a heart transplant after an outpouring of public support helped her to meet a hospital's fundraising recommendation.

Spectrum Health confirmed Friday that Hedda Martin, 60, is back on its transplant list and will undergo surgical implantation of a ventricular assist pump as a "bridge" to the future transplant. It was not immediately clear how long she may have to wait for her new heart. As of Nov. 1, 159 people in Michigan were waiting for a heart transplant, according to United Network for Organ Sharing data.

A transplant committee with the Grand Rapids-based hospital system previously ruled Martin ineligible, citing her lack of financial wherewithal to afford the necessary anti-rejection drugs with the $4,500 annual deductible in her Medicare plan.

Along with that initial rejection, the committee recommended that Martin undertake a $10,000 fundraising campaign for the drugs. Martin's story went viral on social media and nearly 500 people contributed a total of $30,730 to a GoFundMe campaign for her medications and transplant.

[George II]

26. The fact is this was decided by the medical provider itself....

Insurance companies had nothing to do with the decision. No mention of the reason for the "committee" decision.

This was fully discussed back in 2018, I'm wondering why it's being dredged up now in 2020 without any background.

[Celerity]

32. ask the OP, but regardless, it is outrageous that (whomever is calling the shots for denial) that

people have to resort to private fundraising to get life-saving care and operations.

Ofttimes it is insurance companies, and ofttimes it is the providers (like in this case) themselves who throw a spanner in the works.

And to infer insurance had nothing to do with it is disingenuous, as her Medicare (which is federal health insurance) high deductible was the reason given by Spectrum for denial.

Single payer is not the only way to get there (to sort this), but the system is broken for so many.

[George II]

41. Even that's not totally true. The "denial" was for immunosuppressive medication coverage....

....NOT the heart transplant surgery itself. It's right there in that brief letter.

But in fact that medication is covered by Medicare:

https://www.myast.org/public-policy/key-position-statements/immunosuppressant-drug-coverage-under-medicare-part-d-benefit

There are a lot of questions about this entire 2-year old situation. I wouldn't be surprised if there are several factors involved over and above what is stated there.

[Celerity]

45. No, now you are openly making a false statement.

The "denial" was for immunosuppressive medication coverage....
....NOT the heart transplant surgery itself. It's right there in that brief letter.

That is a false statement. She was denied the operation itself due to a lack of funds at that time to cover the post-op immunosuppressive drugs due to her high deductible. If a transplant patient doesn't take immunosuppressive drugs then their body quite likely will reject the transplanted organ. Been through this with my wife's uncle and a liver transplant here in Sweden.





You can keep on making false statements (like you just did) and trying to raise more FUD on the whole thing, but I am done here. My replies stand.

[diva77]

71. THIS!!!!! Thank you

well said

[paleotn]

39. I wonder if the provider

ran all this by Medicare and supplemental insurance and got a total reimbursement that wasn't economical? Sorry, Ma'am, but that's not going to be enough. It is a business after all. Medicare is inadequate outside of basic care and insurance is a business too. The two terms that pop out to me are inadequate funding and business. Maybe that's not the way to do equitable medical care?

[NurseJackie]

83. So much missing information and missing context. Was this just an "oversight" or...

... was there something more? Was it intentional?

I'm wondering why it's being dredged up now in 2020 without any background.

You're not alone in that. I'm wondering too.

[smirkymonkey]

40. Wow. Powerful video.

The state of "healthcare" in this nation is abysmal. It is inhumane. And republicans want to make things even worse. How anyone can vote for them, just knowing what they want to do to eliminate health care options for people , is completely mind-blowing.

[Captain Zero]

44. Hit the donut hole in a Medicare Drug Plan

And next up is the deductible you pay out of pocket.

If you are close to year end you can use GoodRX, but not in conjunction with Medicare, and that will be significantly less for something like insulin, and get you over to the new plan year.

Even with GoodRX it can be steep for many people.
156 for a month of Humalog
506 for a month of Tresiba.

In the donut hole on Medicare it's 900+ for Humalog.

[TryLogic]

48. Has anyone tried Amazon Pharmacy? It's very new.

[LuvNewcastle]

59. I've tried it.

They're fine if you've been on the same meds for a long time and you're unlikely to change anything. If your doctor tends to adjust the dosage of your meds or if he switches them or changes your orders in any way, Amazon is probably not the best place for you to fill your meds. For me, the convenience of using a local pharmacy is too important to sacrifice for having your meds separated into compartments for you. And with my insurance, the local pharmacy doesn't cost any more than Amazon.

[thesquanderer]

21. They did not mention GoFundMe in particular...

...they just said she should try to fundraise $10k for her meds. GoFundMe would be one of the more well known ways to try to do such a thing, and was in fact the method she tried (and succeeded with).

You can get an overview of the details at https://www.snopes.com/news/2018/11/28/heart-transplant-funds/

Using "GoFundMe" as a stand-in for "a fundraising site" would be like saying "eBay" instead of "an auction site." Maybe not precise, but accurately makes its point, and in this case describes what they actually did. I think it's a reasonable representation, even if not literally true that they recommended GFM in particular. A point reduced to a tweet is not typically the place to look for all the fine detail anyway.

[Celerity]

38. +1

[Dem4Life1102]

23. See post #18

[cp]

11. Holy shit

Parasites.

[doublethink]

54. Yeah that's all I could think of too. Holy Shit. SMH. n..a.

[Celerity]

12. K & R

[theaocp]

15. Mm-hm.

Can we please put to bed the myth that people like their insurance? Nobody likes their fucking insurance. They like knowing they're covered. Worlds of difference. Christ.

[zentrum]

35. 100% agree. But you'll

……have a hard time putting it to rest around here.

[panader0]

16. There's a movie about this with Denzel Washington: John Q

https://en.wikipedia.org/wiki/John_Q.

[lapucelle]

18. This tweet is two years old.

This story got wide coverage at the time it happened. It was reported that Hedda Martin was on Medicare, but that she had a high deductible co-pay on her prescription coverage plan.

Michigan Live and The Detroit Free Press also had stories in 2018. The Detroit Free Press disputes that Spectrum Health is an insurance company, characterizing it as a hospital system instead.

Ms. Martin has had her transplant and her recovery seems to be going well. She wound up raising $30,000 and is actively fundraising for others who need help.

Link to tweet

https://www.mlive.com/news/grand-rapids/2018/11/incoming_congresswomans_tweet.html

https://www.freep.com/story/news/local/michigan/2018/11/25/hospital-suggests-crowdfunding-michigan-heart-transplant/2109154002/

[George II]

28. Inasmuch as this woman was a MEDICARE recipient....

....this kind of destroys the concept of "Medicare for All".

I suspect there was a lot more involved than just this brief letter.

[betsuni]

55. Yes, Spectrum Health is a not-for-profit health care organization, not insurance, and

it was Medicare that was inadequate, not a private insurance company. So I don't get it. When people talk about Medicare it sounds incredibly complicated, don't know how people manage to figure it all out.

And if it's true Medicare involves private insurance companies, wouldn't Medicare for All? Wouldn't that be bad if all insurance companies are bad?

[Caliman73]

99. Not really.

Medicare is Federal Health insurance for elderly or disabled people. You pay premiums and there are coverage exclusions and gaps that were put in intentionally by lobbyists for the private for profit insurance industry to hobble competition.

The inadequacies in the health care system are there primarily because healthcare is largely a for profit commodity and health insurance is the mechanism by which the majority of health care is paid for.

There likely was a great deal more involved in this situation, however, the point remains that the "costs" associated and the payment responsibility for a life saving operation was denied because of a lack of funding and the denying party suggested private fundraising as an option.

What we have to decide as a nation, like many other nations have decided, is whether healthcare is a right, or a commodity. If it is a commodity, then we can just continue to operate as we have been. The market will sort things out and people who can afford the price points indicated, will get care, and those who cannot will do without. If healthcare is a right, then we have to figure out a better solution to fund healthcare than insurance, because the model that makes insurance feasible as a business is expanding the customer base and limiting liabilities which means not insuring people at risk of higher costs and finding a way to deny coverage that doesn't appear to be for the sake of profit (though it is definitely a part of it).

The appealing part of Medicare in the "Medicare for all" movement is that the satisfaction rating is typically higher or the same for Medicare than for other insurance the administrative costs are typically 3% to 5% as opposed to 15% (which is the limit imposed by the ACA) for private insurance. It is a model that is familiar to many people, which is why it has been set up as an alternative model.

[Evolve Dammit]

30. U.S. corp.system of "health care" is so fucked up for profit at every level. Dr's I know fired/quit.

[zentrum]

34. She's great.

Hope she becomes President some day.

[marie999]

36. I'll stick with the VA Healthcare system.

I have been with them since 1995 and I have never been turned down for anything.

[TryLogic]

49. We need that evil "socialized" medicine for all.

[questionseverything]

50. Yep we all pay for it but only some benefit

Same for politicians,cops,firefighters,postman,teachers ect and the soulless ghouls who work for the insurance companies.......we all pay for their health care while the low wage workers go with out

[bluescribbler]

37. Could they be any more transparent?

Their greed and callousness knows no limit.

[Autumn]

43. Suggesting fundraising for a lifesaving transplant. What fuckers.

[StClone]

46. AOC calls attention to what has been going on for years

[AmericanCanuck]

51. Hillary Clinton said this (sans the gofundme) in 1993

President Obama said this during the formulation stage of the ACA. Before that, LBJ also said it when medicare was being debated.

This is nothing new -- but proceed with the fan club cheering.

[Celerity]

60. ...

[AmericanCanuck]

62. I supposed you have nothing to say except some meaningless gifs

[Celerity]

63. meaningless gifs

https://www.democraticunderground.com/100214637945#post60

[AmericanCanuck]

64. Oh good

Thanks for admitting there is a fan club that cheers tweets that are copies of what other have said in the past.

(sweet smile)

[betsuni]

65. +1

[Celerity]

68. lol, you +1'd a fail

[betsuni]

70. You think Democrats haven't said the same thing for decades?

Haven't tried to get universal health care since the '60s? There haven't been TV shows and movies saying the same thing about insurance companies for decades? This isn't a mainstream concern that Americans know about?

You're saying this is a fan club and not reality? Why did Democrats do so well in 2018? Health care. What are you talking about?

[betsuni]

74. "It is like clockwork."

[sheshe2]

80. Wait a second.

I think you should delete this post. I am beyond shocked and truly upset with the image that you are posting in Cortez's name. I may not care for the woman yet this is outrageous. That woman is smashing a child against a wall. Why are you posting this? She/ AOC would never abuse a child.

Delete your post!

[melman]

67. So this problem is all solved and there's no reason to talk about it anymore

What a relief!

[AmericanCanuck]

78. The problem has existed for decades

Even Nixon tried to pass a universal health care.

Many presidents have tried.

The problem is that people who have health insurance are not willing to give it up.

Tweets will never change that. If anyone is serious, initiate legislation instead of tweeting to the fan club.

[Autumn]

88. This is an old story! This has gone on for years! They eventually got their surgery!

Last edited Mon Nov 30, 2020, 12:34 PM - Edit history (2)

Fan club yadda yadda. Why she gotta be so... Divisive! Problem solved. HUGE relief!



Something like that should NEVER happen in our country.

[George II]

69. OLD tweets at that!!!! I hear George Washington once said something bad about Benjamin Franklin!

[betsuni]

73. +1

(OMG, I +1 a "fail" again!)

[Celerity]

75. Actually you did. The poster got caught making a flat out false statement upthread.

https://www.democraticunderground.com/100214637945#post45

[betsuni]

76. No, the surgery was denied.

[melman]

81. That's what they said

[George II]

85. Reread the tweet in the OP, please.

The original premise of the (2-year old) tweet is "insurance companies are recommending GoFundMe as official policy".

1. The letter was from the medical provider, not an insurance company
2. Nowhere was GoFundMe mentioned in the letter, nor it is "official policy"
3. There were no insurance companies involved whatsoever, the woman is a Medicare patient

Finally, as stated before:

4. The letter states that she was (temporarily) denied not because she couldn't afford the surgery itself (Medicare pays for that) but because she needed a "more secure" (not non-existent) financial plan for immunosuppressive medication coverage

Incidentally, the woman has had her initial surgery and is recovering satisfactorily, awaiting availability of a suitable heart donor.

[melman]

77. Same one twice

[AmericanCanuck]

79. All some people have are tweets

Meaningless exercise in seeking attention.

[betsuni]

82. "Same one twice"?

What?

[melman]

98. Yes

Exactly.

[Arazi]

52. This has always been the case. A dirty little secret

If you don't have the money for a transplant and post-transplant meds you are SOL.

This isn't new

[Caliman73]

100. Yes. It isn't new. AOC is trying to bring attention using social media.

Do you think it is a good thing or a bad thing that she is trying to bring attention to the issue?

[TristanIsolde]

53. When we on the left say the options are: "Socialism or Barbarism"

This in an example of the barbarism we are talking about.

[UCmeNdc]

84. Go with a medicare for all program at the very minimum.

Look at the countries of:
Germany
Switzerland
Norway
Niederlande - Netherlands
Sweden


They all have great government run health programs.

[BobTheSubgenius]

91. GFM is hardly the only option.

Bake sales, bottle drives, straight-up panhandling at malls and grocery stores - all viable. And let's not forget the Mother Lode of alternative financing - Powerball.

They need to think outside the box. Pun intended.

[Lunabell]

92. We really need medicare for all.

[SpankMe]

93. Here's the original Tweet:

1. Yes, it's 2 years old. AOC had just won her House seat and was still on a roll. So what?
2. The poster decided to post it yesterday. Perhaps they didn't know it was old news. Or, they just wanted to post something they encountered only recently that moved them. So what?
3. Yes, GoFundMe isn't explicitly mentioned in the letter. I don't see the problem, though. AOC's mention of GoFundMe is clearly a rhetorical flare designed to make a point with a wry emphasis and in accordance with her personality.

I do not understand the severe nit-pickiness of some of the responses here. These minor excursions from exactness are easily explained without all the back-and-forth.

Link to tweet

[Martin Eden]

94. This reminds me of the 2002 Denzel Washington movie: John Q

Plot summary

John Quincy Archibald's son Michael collapses while playing baseball as a result of heart failure. John rushes Michael to a hospital emergency room where he is informed that Michael's only hope is a transplant. Unfortunately, John's insurance won't cover his son's transplant. Out of options, John Q. takes the emergency room staff and patients hostage until hospital doctors agree to do the transplant.