No CLASS Act

Not surprisingly, President Barack Obama caved in on another part of his health care "reform," this time about long term affordable care. Also called Community Living Assistance Services and Support, this part of health care "reform" was supposed to prevent the elderly from financial catastrophe which resulted from paying for expensive, chronic and skilled nursing care.

Long term care insurance has been around for at least a couple of decades. My mother looked into it, but was hesitant to buy it because she simply didn't trust insurance companies. What if the policy changes, she worried? What if an insurance company merged with another and no longer honored the policy? The former was more likely to happen than the latter, and her fears won out. Under Obamacare, the requirement to purchase long term care insurance would kick in 2014. Great! I thought, when read that. Yet another gift to fat cat insurance companies.

I am not unhappy that Obamacare is unraveling because it is a terribly flawed and compromised law that served few people. The first issue with the idea of health care reform is that too many people, particularly decision makers, seem to think that there are simple solutions for it. There aren't any. It is not just a matter of people's taking responsibility for their own health (e.g., eating healthy foods and exercising) or knowing what medical care costs are (try that when you go to your nearest ED). One New England professor said decades ago that what the U.S. has is "neither health care nor a system." That's the problem in a nutshell. If you follow the money, you'll see that it's this way simply because there is money to be made by a few.

Here is one example. This past summer, my mother suffered from a very rare, agonizing and debilitating disease. It's so rare that there's nothing on it on the websites of my go-to sites, The Mayo Clinic, CDC, NIH or even NORD (National Organization of Rare Disorders). She was completely misdiagnosed by the first doctor. She walked into his office with some discomfort. Ten days and two visits later, she needed a wheelchair and pain medicine, which he would not give her. Three other doctors who were affiliated with another hospital were interested in her case. The first one insisted that she go to the ED, where he would meet her. One remembered seeing a case such as hers during her internship. She called a friend of hers in Texas for advice, but he was not very helpful. Those doctors then threw up their arms and left it to us to find a dermatologist who might be able to help. I did, but after making several calls, I only found five doctors between Washington, D.C. and Boston who have had experience in treating the disease she has. In the meantime, four doctors billed Medicare to the tune of tens of thousands of dollars (including about $12K billed by the hospital for one afternoon in the ED!). The procedures, diagnostics and lab work prescribed by the four doctors in two towns, which are fewer than 10 miles apart, varied significantly in cost.

One of the valid criticisms of Obamacare -- and the current "system" that is in place -- is that there are no provisions to reign in costs. How can there be? There are no standards. As I mentioned, these four doctors are not practicing in areas that are distant from each other and thus have a wide range of rental costs, labor costs, etc. None of the pundits of health care in its current state or in a political reform will address the issue of what is health care worth? How much should an MRI cost? How much should "observation" cost? (For the record, there was no nurse or other health care provider in the ED with her at all times. I was there and I didn't get paid a penny. Nor was my mother continuously hooked up to monitors.)

So, it's back to the drawing board. But people -- anyone involved in the insurance system or not -- should do some serious story boarding and follow the money.