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Cancer patient loses Insurance, sad Medical doctor cries!
Milwaukee Sentinel ^ | March 22, 2010 Health | JOHN FAUBER

Posted on 03/22/2010 8:52:30 AM PDT by Wontsubmit

For nearly a decade, Paula Oertel's brain tumor was kept at bay by a drug that was not approved to treat her condition.

Then Oertel did something she never imagined would jeopardize her good health.

She moved -- less than 30 miles -- from one county in Wisconsin to another.

That move triggered a review of her health insurance from Medicare, which eventually led to a loss of coverage, including the drug.

And the tumor returned within four months.

What happened to Oertel stunned her doctor, Dr. Mark Malkin. Nothing he learned in medical school prepared him for what now is too often a sad and frustrating part of his job as an oncologist: fighting Medicare and private insurance companies over life-or-death decisions.

Doctors aren't supposed to get emotionally involved in the cases of their patients, but tears well up in Malkin's eyes when he talks about Oertel, the 40-year-old Oshkosh woman he has been treating for several years.

"I wish Paula would have a second chance," he said, choking up.

(Excerpt) Read more at abcnews.go.com ...


TOPICS: Culture/Society; Government; News/Current Events
KEYWORDS: health; insurance; medicare; obama
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To: jackibutterfly

And most likely the research that resulted in the drug was done at the expense of the taxpayers via the NIH.

Socialize the costs, privatize the profits. What a plan!


41 posted on 03/22/2010 9:52:03 AM PDT by dfwgator
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To: Nachum
Too bad the doctor didn't offer to treat her at his own cost, donate his own time, and his own services for free...

you can't. It's against the law if you charge Medicare patients a fee then you have to charge all your patients. Gee, what do you think doctors are??? compassionate or something. The government made a point out of "giving away" services that they are charge for.

You know why of course????

It's not "fair".

Beautiful, it's a Catch-22. So unless he wants to charge all his medicare patients zero, he has to bill her.

The whole system is designed to make the doctor patient relationship antagonistic in order for the government to come in and control the proles.

As far as the comment about "rich" doctors... they have good cash flow but if you look at the debt the ones now are graduating with and what you have to borrow to set up a practice, you'll see a person with delayed payout over about 20 year period of time.

The big house that doctors have... the reason is that in most states your primary residence can't be taken by a malpractice verdict that goes over your insurance limit. So you load up with as big a house and/or property you can borrow and sell it off when you retire. It's like re-insurance for bankruptcy. Same with primary vehicle for work.

It's all a big game for the politicians/lawyers to get everybody to fight against each other when we should be treating them like Mussolini after the war.

42 posted on 03/22/2010 9:52:41 AM PDT by erman (A day without democrats is like a day without toilets backing up)
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To: Neets

Disability-SSI. She is disabled from her cancer and eligible for Medicare.
Wonder if Zeke Emanuel helped with the rationing decision.


43 posted on 03/22/2010 9:53:48 AM PDT by grumpygresh (Democrats delenda est)
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To: Neets

Sorry that you can relate! and thanks!


44 posted on 03/22/2010 9:54:15 AM PDT by DieNarrin (Artificial Intelligence is no match for Natural Stupidity!)
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To: Trust but Verify

The point of the story is to print the headline “Cancer patient loses her Insurance”. The truth be damned.


45 posted on 03/22/2010 9:55:57 AM PDT by Republic of Texas (Socialism Always Fails)
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To: RC2
From what I have read the insurance is currently designed for ex-pats. However, it has been used to given Brits and others with National HC access to USA health care. Other than ex-pats it has been part of the growing medical tourism boom. I am guessing that if it pays, private doctors will accept it. My wife and I are looking at some policies to hedge our bets. In 10 years I may need health care and be told I am too old. This will give me the option even if it means going to the Philippines or Costa Rico. I can afford it so why not? By the way, I have a bad shoulder, while on active duty I was refused surgery because, I was too old, when I was preparing to retired the VA doctor concurred. Rationing in the federal health systems already occurs, imagine what is coming.
46 posted on 03/22/2010 9:56:00 AM PDT by OldGoatCPO
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To: grumpygresh

Ole Zeke is Obama’s Mengele and Rahmbo is his Henrich. I wish I had the money to put that on a billboard!


47 posted on 03/22/2010 9:57:43 AM PDT by OldGoatCPO
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To: Wontsubmit

Medicare paid 22,500 a month for drugs that limited\didn’t work but wont pay 8,000 a month for drugs that do work.

there has to be a better way to handle all this.

sad part is, under OBama care, she probably would have faced an end of life doctor by now.


48 posted on 03/22/2010 10:04:32 AM PDT by stylin19a (Never buy a putter until you first get a chance to throw it)
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To: jackibutterfly

My mother is on a targeted therapy for stage IV lung cancer. The drug is given orally and therefore covered under Medicare part D rather than Medicare part B as her chemo was.

The prescription is $4,000 per month. I thought that was shocking too until I did some research. It cost the company that developed the drug $1 billion to develop it and bring it to market. Unlike a drug that has a wide potential market (think Nexxium for heartburn—anyone is a potential user), this drug is only approved for treatment in advanced Lung Cancer and Pancreatic Cancer. A very small market and not every patient with those diseases will survive long enough to get this drug.

Still $4,000 per month is steep. But when I checked my mom’s Medicare statement I discovered that the chemo she had been off and on for three years was $10,000 a treatment—and she was getting that every three weeks. So by comparison, the $4,000 per month is a bargain, but Medicare won’t classify it as a chemo, because she takes the drug by mouth.

Mom and Dad are retired and cannot afford $4,000 per month. Good thing they have a Medicare part D plan. This drug is considered tier IV so initially Medicare pays 2/3 and Mom pays 1/3 until she hits the doughnut hole (which is in the second month for this drug). Her co-pay ended up being about $1,500 for January and about $2,700 for Feburary. After that she was through the doughnut hole and will pay about $200.00 per month for the rest of the year. Better, but those initial co-payments place the drug out fo reach.

But that is still not the end of the story. The manufactuer provides grants to Seniors (actually anyone)who cannot afford their co-pays. Total actual monthly cost for the drug? $25.00

For mom, it is really the evil drug company that is making it possible for her to afford to take this drug. And the drug is working wonders. She is full of energy, feels great and is living her life. Three months ago she was coughing all the time and rapidly growing weaker. I’m not sure she would still be with us but for this expensive drug.

My fears: first that Obama care is going to deny treatment for anyone with a Stage IV cancer. The comparative effectiveness research panels will look at drugs like the one my mother is on and decide they are not worth the expense. Second that they are going to place such a burden on drug manufacturers that they will slow down or cease drug development for cancer treatments. Third, that it will be almost impossible for Medicare patients to see doctors on a timely basis because so many physicians will stop accepting Medicare patients.


49 posted on 03/22/2010 10:06:24 AM PDT by rhetorica
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To: rhetorica

All the best to your mom!!!


50 posted on 03/22/2010 10:11:05 AM PDT by Neets
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To: erman
Beautiful, it's a Catch-22. So unless he wants to charge all his medicare patients zero, he has to bill her.

Actually, if he was found not billing her for her copays under medicare, he would be cut off from medicare. Oh, he could treat her for free if he was willing to let go of all of his medicare patients.

There is a way around that. He could treat her anyways, bill medicare and let the claims be denied, the copays go unpaid, and write it all off as a loss. If she lives, she declares bankruptcy. If she dies, no one cares anyway.

He could have got it done.... if he wanted to.

51 posted on 03/22/2010 10:19:02 AM PDT by Nachum (The complete Obama list at www.nachumlist.com)
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To: rhetorica
My fears: first that Obama care is going to deny treatment for anyone with a Stage IV cancer.

Not for all. The existing treatments would be rationed. Only the right kind of people would get what they needed. Only those who had friends in high places, those who bribed their politicians, doctors, and bureaucrats would have the clout to get to live to see another day.

Just like in every other socialized or communist country.

52 posted on 03/22/2010 10:22:23 AM PDT by Nachum (The complete Obama list at www.nachumlist.com)
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To: Nachum

you can’t write off “no pays” as a loss.


53 posted on 03/22/2010 10:29:50 AM PDT by erman (A day without democrats is like a day without toilets backing up)
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To: erman
you can’t write off “no pays” as a loss.

Are you saying that doctors are forced to count uncollected payments as earned income?

54 posted on 03/22/2010 10:31:56 AM PDT by Nachum (The complete Obama list at www.nachumlist.com)
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To: Nachum
In the end, I just thought about this. He actually helped the United States by having this person die. Less out of Medicare so we can fund ACORN and other kewl things in the health bill.

So Stupak was right in saying the democrats are the party of "life". They know how much you're worth right down to the penny.

Now I just know that fat Teddy Kennedy would have been cut off the medication cause all of us are equal. /sarc

55 posted on 03/22/2010 10:33:06 AM PDT by erman (A day without democrats is like a day without toilets backing up)
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To: TonyInOhio

RE: “When government pays the bills, government makes the rules.

All animals are equal, but some are more equal than others.”

*****************

More equal than others — hmmm — this has been a long time coming. Worked for a large health insurer for years and we all noted that welfare monkeys got the BEST of care thanks to CA’s version of Medicaid, “MEDI CAL” — not sure what happens next but the wrong people are definitely now having our assets redistributed to them more and more.


56 posted on 03/22/2010 10:36:53 AM PDT by CaliforniaCon (,)
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To: RC2

RE: “Read the Health Bill. You can keep your insurance IF and it’s a big IF.....you don’t make any changes to your policy. Once you make changes, you will loose the insurance. Just changing your address will make a difference. Soon, you will have to ask permission to change your residence. This is exactly what happened in the USSR. The government had to approve where you lived. Our government will start this with health care and then take it to the general public. It will take years but it will happen if the people let it.”

*****************

Yes, not only did you need permission to change residences, they were TOLD WHERE THEY WOULD LIVE AND WITH WHOM. Apartments (tenements) in Moscow, for example, were shared with relatives and adjoining units shared bathrooms with other families.

There was NO competition, no choice in anything. Markets carried one ‘brand’ — the govt. brand, i.e., USSR green beans! No quality control, nothing — everything was in disarray, grey and dull and the people beaten down. I was there in ‘77 and again in ‘85 and believe me, ‘85 was a little better because Gorby had taken power and things were opening up a LITTLE bit. We actually saw Pepsi trucks in ‘85 unlike in ‘77 when the whole country was under siege by the commies.

Look out Amerika, it’s coming — incrementally but it’s coming!!!!


57 posted on 03/22/2010 10:42:35 AM PDT by CaliforniaCon (,)
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To: Neets

RE: “Medicare is usually the senior citizen health care.

She is only 40?

Something doesn’t smell right here”

***************

She probably fell into some category that allowed her to get Medicare early. I knew a guy with a bad kidney condition needing dialysis 4 days a week. He could not hold down a job because he was always at dialysis and then felt horrible for 6 hours afterward. But.... finally got a transplant and is STILL on Medicare! So there are tons of loopholes to getting on Medicare.


58 posted on 03/22/2010 10:46:02 AM PDT by CaliforniaCon (,)
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To: Sacajaweau

RE: “I’d guess she’s on disability...which I believe makes you eligible for medicare at any age...”

************

Yes, and some of them STAY on disability and thus Medicare coverage until they either die or recover, if then. I know one who’s been on Medicare for YEARS due to medical problems and he is not even 60 yet.


59 posted on 03/22/2010 10:49:16 AM PDT by CaliforniaCon (,)
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To: Neets

You can get limited Medicare if you are catagorized as disabled.


60 posted on 03/22/2010 10:54:48 AM PDT by call meVeronica
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