Insurance Fails to Cover, Mom Goes Blind So Daughters Can See

by TheCameraObscura | September 28, 2009 at 02:43 pm

400 views | 52 Recommendations | 9 comments

We've all heard the doomsday scenarios of what may happen if the U.S. finally has universal health care: old people will die, babies will die, people will go to jail, etc... Here is an actual scenario that is occurring right now under corporate healthcare.

Monique Zimmerman-Stein has been nearly blind for the last two years from Stickler syndrome, a rare genetic disorder. She recently decided to forego her own treatment to save funds to treat her two daughters, who also suffer from the condition, reports Lane DeGregory of the St. Petersburg Times.

The family is covered under husband Gary’s Blue Cross/Blue Shield plan, but that coverage only pays for 80 percent of medical expenses.

She will no longer get treatment to preserve that last slice of light. The injections that might help cost $380 after insurance, and she needs one every six weeks. She could be spending that money on her daughters’ care.

If forgoing treatment might help them see, she said, “That’s a choice any mom would make.”

The expensive care has already forced the family out of their home, which was foreclosed, and forced them to sell their furniture and to cash in their life insurance.

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a211423

at 16:57 on September 28th, 2009

Thank you for posting this story because Americans need to know whats happening to people under the non-system we have now. This Mom is truly a hero, and she is doing what most of us would do when it comes to our children. Someone needs to come forward for her NOW. This should not be happening.

If this isn't a reason for universal health care, I don't know what is.

TheCameraObscura

at 20:35 on September 28th, 2009

Yes, she is a true hero.

The Republicans and Blue Dog Democrats who are blocking the public health care option should be ashamed of themselves.

Uwe Paschen

at 17:10 on September 28th, 2009

Even universal care such as in Japan and France does not cover 100% any longer.

The reason the governments in Europe and Japan have change this from 100% down to 90 or even only 70% was due to the amount of abuse by the Public and the health care workers that over charged and over treated.

Still universal health care is better, since it does insure all Citizen with out discrimination.

TheCameraObscura

at 17:22 on September 28th, 2009

From the WSJ:

Today, Assurance Maladie covers about 88% of France's population of 65 million. The remaining 12%, mainly farmers and shop owners, get coverage through other mandatory insurance plans, some of which are heavily government-subsidized. About 90% of the population subscribes to supplemental private health-care plans.

From the Washington Post

Health care in Japan -- a hybrid system funded by job-based insurance premiums and taxes -- is universal and mandatory, and consumes about 8 percent of the nation's gross domestic product, half as much as in the United States. Unlike in the U.S. system, no one is denied coverage because of a preexisting condition or goes bankrupt because a family member gets sick.

I'm just curious, in what ways does the public abuse health care?

Uwe Paschen

at 23:52 on September 28th, 2009

The Abuse was through out the 70s into the 80s, over use of medication since that one was free, prescription where those where not warranted.

Over use of specialist and expensive equipment such as MRI, when those where not warranted or needed.

Why, the patient participation of 10 to 30% of the cost was implemented. Further more controls where implemented as well to seek out Doctors that over charged the system.

Those abuses cost dearly and are compromising the effectiveness of the health care system as well.

France has countered the problem by making the patient pay the total cost up front and then reimburse then after they file their claim. The patient needs to have enough cash up front first before he or She can get treated even though 88% of it will be reimbursed with in 3 month.

Japan makes the patient pay for every visit to the doctor but not for the treatment and only 20% of the medication fee.

Barbara McPherson

at 18:24 on September 28th, 2009

People are only as healthy as their population as a whole. A health condition shouldn't push people out of their homes. In BC we do have the option of buying extra coverage, but if we contract something horrible like kidney disease or cancer, that care is provided with no extra charge. There is no charge at all for emergency care at the hospital. If your kids have a bad cold or a sore throat, you take them to the doctor's without charge. You would have to pay for the antibiotics, etc. if you didn't have a plan. People in BC that qualify because of lower income pass a means test and get aid in paying for prescriptions. The system is a long way from perfect, but it is way better than the alternatives.

The_Cynic

at 20:09 on September 28th, 2009

In the UK you are covered from cradle to grave with National Insurance that does equate to 17% of your income (you pay this each time you are paid either monthly or weekly). But no one is every turned away. And the last figures I know of the cost per GDP was 8.5%.

Most people do not pay for 'script charges but if you are charged you pay about $12.00 - you have to be earning a certain income before that kicks in.

menahunie (not verified)

at 02:52 on September 29th, 2009

Some one explain to me why an MRI costs $1,000.00 EACH? I know the machine costs money; but kaiser here has had the same machine I know of over 20+ years; yes I know there was some equipment upgrades.Explain to me why a mortrin or Tylenol pill in the hospital cost 10-20.00 EACH?Explain to me why an ace bandage say for a sprained wrist costs 50-70.00 Each? When you can buy either the pill about three bottles worth or the bandage for 10.00 in a drug store.Explain to me why it costs over $20,000.00 A DAY in a Coronary ICU? What were the costs to Kaiser for charging that amount?Explain why just walking into an emergency room it costs $450.00 just for being there? This isn't even when you have been seen yet?Explain how Kaiser a NON Profit Company - THEY PAY NO TAXES ON ALL THE MONEY THEY EARN KEEPS SHOWING A $500,000,000.00 PROFIT in Hawaii with a population of around Two Million people??????????Explain how when you ask the HMO like Kaiser how much is the surgery going to cost and they can not or will not tell you until it is over THEN YOU GET THE BILL.....OBAMA has Health Care reform ass backwards; he has put the cart before the Horse. REQUIRE the Health Care Providers PROVE THE CHARGES THEY CHARGE THEIR CLIENTS. Enact a National Medical Prescription Coverage Plan TO START.Enact Legislation requiring Insurance Companies to PROVE WITH MEDICAL DOCUMENTATION WHY THEY DENY TREATMENT. They can not do this then they deserve a HUGH FINE and PAY THAT CLIENTS MEDICAL TREATMENT AND THE PAIN AND SUFFERING AND MOST CASES DEATHS MONEY. Then maybe they will approve JUSTIFIED TREATMENT IMMEDIATELY... I MEAN JUSTIFIED by at least three doctors who agree the treatment is required. If in case of life or death if treatment isn't given quickly; THEN IT IS GIVEN PERIOD. Too many Insurance companies are pronouncing a DEATH SENTENCE ON TOO MANY OF THEIR CLIENTS...Obama does that for starters then we are heading in the right direction for common sense health care reform.

a211423

at 06:40 on September 29th, 2009

All your points are well taken menahunie. And thats why hospital charges are one of the most striking areas and has been cited as an area where there is waste in the system.

This is why 25-30% of the premiums paid for health insurance go for administrative costs. There is a tremendous area where costs can be reduced, and should not effect quality or delivery of health, nor does it effect the amount paid to doctors. It is estimated that in 2006 186 billion dollars was spent on administrative costs and some estimates of profits are between 25-30% .