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Politics : PRESIDENT GEORGE W. BUSH -- Ignore unavailable to you. Want to Upgrade?

To: ColtonGang who wrote (157657)	7/4/2001 4:51:16 PM
From: ColtonGang	Read Replies (1) \| Respond to of 769667

THE HAVES AND THE HAVENOTS............Could just anyone get a pacemaker like Cheney's? Not necessarily, HMO critics say. And Bush has already promised to veto a bill that would help patients get care as good as the vice president's. - - - - - - - - - - - - by Alicia Montgomery July 4, 2001 \| WASHINGTON -- Vice President Dick Cheney never had to worry that his Blue Cross/Blue Shield federal employee health insurance policy would fail to cover the cost of the $25,000 to $30,000 implantable cardioverter defibrillator (ICD) installed Saturday, along with the other expenses of his recent hospital stay. While he hasn't yet received confirmation from Blue Cross/Blue Shield that the bill will be paid, Cheney spokeswoman Juleanna Glover Weiss tells Salon that Cheney assumes his policy will cover it, simply because he's a patient whose doctors decided he needed the treatment. But according to some healthcare watchdogs, the procedure Cheney had could be denied by many HMOs. And in a strange coincidence, the major piece of legislation moving through the Capitol's corridors right now -- a patients' bill of rights -- would make it easier for patients to demand such coverage should their insurance carriers try to block it. It passed the Senate the day before Cheney entered the hospital, but President Bush has vowed to veto it. Several critics of managed care say that, had Cheney been an ordinary cardiac patient enrolled in an HMO, he would have had to wait or fight or both to receive the ICD that now regulates his cardiac arrhythmia. Cheney has insisted at press conferences that the implant wasn't a life-or-death matter, but merely "an insurance policy," an assertion supported by his own doctors. "I was kind of struck with the fact that Cheney needed it, they approved it, and then he got the implant," says Dr. Linda Peeno. Once an HMO claims reviewer, Peeno now serves on the ethics committee at the University of Louisville teaching hospital and has testified before Congress about methods some HMOs use to stand between their clients and necessary medical treatment. "This is exactly the type of technique that the HMOs would treat as not medically necessary because he could live without it," says Jamie Court, executive director of the Foundation of Taxpayer and Consumer Rights and author of "Making a Killing: HMOs and the Threat to Your Health." And Ron Pollack, executive director of the nonprofit healthcare watchdog group Families USA, agrees, insisting that ordinary managed care clients would be encouraged to make do with a course of treatment like medication to correct the irregular heartbeat that Cheney suffers from: "You could bet that regular HMO patients are not likely to receive this procedure because it is expensive." Even Dan Stryer, a medical officer at the Agency for Health Care Research and Quality -- an agency within the Department of Health and Human Services responsible for providing the federal government with research about treatment outcomes -- says it isn't clear whether the care Cheney received for his condition, non-acute arrhythmia, could be reasonably expected by the average HMO patient. "There is not a solid standard on this," Stryer said. "Given Cheney's symptoms, you'd have a tough time convincing a lot of cardiologists that it was time for a defibrillator." Not every doctor would call Cheney's ICD a medical necessity, Stryer said, and that's what would be necessary for many HMOs to cover it. Many patients do undergo the procedure, of course. "About 150,000 Americans are walking around with an ICD right now," points out Dr. Douglas Zipes, president of the American College of Cardiology, who adds that, as director of the cardiology department at Indiana University School of Medicine, he has rarely had problems with reimbursement regardless of the patients' conditions. And Mohit Ghose, spokesman for the American Association of Health Plans, an umbrella group for over 1,000 managed care providers, claims that there are both ethical and financial incentives for providers to allow patients to receive the ICD in most cases where their doctors recommended it. "If you can keep people out of the hospital and living their normal lives, that is providing the best care for the best price," he says. But there's enough disagreement about the medical necessity of the ICD that many cardiac patients could end up on the wrong side of the "best care/best price" equation.

To: ColtonGang who wrote (157657)	7/4/2001 5:53:17 PM
From: Ish	Read Replies (1) \| Respond to of 769667

<<Prosecutor Vincent Bugliosi accuses the Supreme Court's conservative majority of criminal conduct bordering on treason >> I heard him on the radio. He's nutz. He went on about how he had "connections" and he was going to make the 5 Justices "pay" for their ruling. An open threat.