and will be indefinitely. Vote smart and stay well.
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Author Archives: Paul Paez
The lifesaver that is the Affordable Care Act
Health care in our country is a very political animal. Because of the huge amount of money there is to be made, namely by the health insurance industry, there are many special interests trying to claim their piece of the pie, and in doing so they have created the mess that is health and care in this country.
What other democratic and industrialized nation in this world has the process of health care delivery sitting before a court that may well decide that people like my husband don’t deserve to be able to purchase affordable insurance to live? The answer is none.
And why do people who have no idea what it is to have a life-altering or threatening disease, through no fault of their own, feel the need to try and take away health care from those who need it?
I have no answer for that but it is something this family is faced with every single day. From people on Twitter who regularly harangue me for speaking out in favor of the Affordable Care Act to yes, family members who are against it, I have to remind them all that the Affordable Care Act is saving lives. I also remind them that getting sick is part of the human condition and some of us get more sick than others.
And without the Pre-Existing Condition Insurance Plan, my husband and many others would die. It is that simple a truth; that black and white.
We pay a premium every month, just like those who have insurance through their employer. Until 2014 when the law is fully enacted (depending on the Roberts court, of course) and the health insurance exchanges are set up, your employer is the only access point for affordable health care.
The PCIP is a pool of people who the health insurance industry won’t insure. Why? Because the health insurance industry does not like to spread their risk pool out to people with diseases like Multiple Sclerosis or cancer because they know they will have to pay claims for these people. It’s the same with Medicare, the health insurance industry got rid of their most expensive risk pool, those over 65, when Medicare was created.
All insurance is a risk pool, we all pay into that pool to cover each other. I may never have a claim because I am healthy but my money goes to cover those who do and vice versa–that’s how insurance works. Imagine if we just opened up the Medicare risk pool to everyone, cradle to grave, and we all had the chance to pay into it. We’d solve all our problems, both with Medicare solvency and with insuring all our citizens.
The next time you hear someone, anyone, claim the Affordable Care Act is not affordable, ask them if they think it’s all right in this country of ours to allow one industry the right to deny care over and over again while taking in billions in profit.
Ask them if health care is not already “rationed” by the health insurance industry, because it is. Just ask the parents of Kyler Van Nocker or Nataline Sarkisyan.
Ask them if my husband, and other citizens of this country, have the right to be able to see their children grow up by having access to medications.
Ask them if denying access to affordable care isn’t infringing on your personal liberty.
Ask them if they even know that Medicare is a government run program that saves senior citizens from bankruptcy and death.
See what they say and the answer you receive will tell you everything you need to know about their morals and their character. Everything.
More on Tovaxin and Phase IIb Clinical Trials
I’m just going to take it straight from Opexa’s press release that I found today on MarketWatch about the “upcoming Phase IIb clinical trial using Opexa’s T-cell therapy in patients with Secondary Progressive Multiple Sclerosis (SPMS).”
We’ve written about Opexa before because they seem to understand that NOT killing the patient is the best way to try and treat Multiple Sclerosis.
Everything below is taken directly from MarketWatch
PRESS RELEASE
April 19, 2012, 8:30 a.m. EDT
Opexa to Hold Preliminary Investigator’s Meeting for MS Trial at American Academy of Neurology Annual Meeting
Dr. Mark Freedman and other Members of Opexa’s SAB to introduce SPMS clinical trial to prospective trial physicians
THE WOODLANDS, Texas, Apr 19, 2012 (BUSINESS WIRE) — Opexa Therapeutics, Inc. OPXA -0.24% , a biotechnology company developing Tovaxin(R), a novel T-cell therapy for multiple sclerosis (MS), announced today that the Company will be holding a preliminary meeting with prospective clinical trial investigators at the 64th Annual American Academy of Neurology (AAN) Meeting in New Orleans on April 24, 2012. The purpose of this meeting will be to discuss the upcoming Phase IIb clinical trial using Opexa’s T-cell therapy in patients with Secondary Progressive Multiple Sclerosis (SPMS).
“We are honored to introduce our next clinical trial to a group of invited neurologists at this year’s AAN meeting in New Orleans,” commented Neil K. Warma, President and Chief Executive Officer of Opexa. “The meeting will be an opportunity to discuss with select clinicians and their study coordinators potential participation in the SPMS clinical trial as well as present the final protocol for the trial including the design, structure and patient selection criteria. This is an exciting time for Opexa, neurologists and SPMS patients as this study will provide an innovative opportunity for treatment in an area where currently there are very few treatment options. The annual AAN meeting is an excellent forum for the MS community to discuss and present new therapies that could have an important impact on the treatment of MS. We are pleased that Tovaxin is generating a great deal of enthusiasm among physicians, key opinion leaders and patients in the lead up to this meeting and are equally pleased to be advancing our clinical plans for Tovaxin.”
Mark Freedman, M.D., director of the Multiple Sclerosis Research Unit at the Ottawa Hospital and member of Opexa’s Scientific Advisory Board, commented, “I am pleased to contribute my expertise to Opexa with their design and planning of this Phase IIb study. Opexa is now in the process of selecting clinical trial investigators and finalizing the remaining steps in order to conduct a study of optimal quality. I am pleased to facilitate the introduction of the Phase IIb study to prospective clinical trial investigators at this year’s AAN meeting. Patients with SPMS have few treatment options and Tovaxin’s safety profile certainly justifies investigation of this therapy in the challenging SPMS patient population.”
The proposed Phase IIb clinical trial will be a randomized, double-blind, placebo-controlled study of Opexa’s T-cell therapy in SPMS patients with evidence of disease progression without associated relapses. The study, to be initiated once the necessary resources are secured, is expected to treat approximately 180 patients in up to 30 sites in the United States and Canada with annual courses of treatment for two years.
About Opexa
Opexa Therapeutics, Inc. is dedicated to the development of patient-specific cellular therapies for the treatment of autoimmune diseases such as multiple sclerosis (MS). The Company’s leading T-cell therapy, a personalized cellular immunotherapy treatment, is in clinical development targeting both Secondary Progressive and Relapsing Remitting MS. Opexa’s T-cell therapy is derived from T-cells isolated from peripheral blood, expanded ex vivo and reintroduced into the patients via subcutaneous injections. This process triggers a potent immune response against specific subsets of autoreactive T-cells known to attack myelin and, thereby, reduces the risk of relapse over time.
For more information, visit the Company’s website at http://www.opexatherapeutics.com .
Cautionary Statement Relating to Forward – Looking Information for the Purpose of “Safe Harbor” Provisions of the Private Securities Litigation Reform Act of 1995
This press release contains forward-looking statements which are made pursuant to the safe harbor provisions of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. The words “expects,” “believes,” “anticipates,” “estimates,” “may,” “could,” “intends,” and similar expressions are intended to identify forward-looking statements. The forward-looking statements in this release do not constitute guarantees of future performance. Investors are cautioned that statements in this press release which are not strictly historical statements, including, without limitation, statements regarding the development of the Company’s product candidate, Tovaxin, constitute forward-looking statements. Such forward-looking statements are subject to a number of risks and uncertainties that could cause actual results to differ materially from those anticipated, including, without limitation, risks associated with: our capital position, the ability of the Company to enter into and benefit from a partnering arrangement for the Company’s product candidate, Tovaxin, on reasonably satisfactory terms (if at all), our dependence (if partnered) on the resources and abilities of any partner for the further development of Tovaxin, our ability to compete with larger, better financed pharmaceutical and biotechnology companies, new approaches to the treatment of our targeted diseases, our expectation of incurring continued losses, our uncertainty of developing a marketable product, our ability to raise additional capital to continue our treatment development programs and to undertake and complete any further clinical studies for Tovaxin, the success of our clinical trials, the efficacy of Tovaxin for any particular indication, such as Relapsing Remitting MS or Secondary Progressive MS, our ability to develop and commercialize products, our ability to obtain required regulatory approvals, our compliance with all Food and Drug Administration regulations, our ability to obtain, maintain and protect intellectual property rights (including for Tovaxin), the risk of litigation regarding our intellectual property rights, the success of third party development and commercialization efforts with respect to products covered by intellectual property rights that the Company may license or transfer, our limited manufacturing capabilities, our dependence on third-party manufacturers, our ability to hire and retain skilled personnel, our volatile stock price, and other risks detailed in our filings with the Securities and Exchange Commission. These forward-looking statements speak only as of the date made. We assume no obligation or undertaking to update any forward-looking statements to reflect any changes in expectations with regard thereto or any change in events, conditions or circumstances on which any such statement is based. You should, however, review additional disclosures we make in our reports filed with the Securities and Exchange Commission, including our Annual Report on Form 10-K for the year ended December 31, 2011.
SOURCE: Opexa Therapeutics, Inc.
Neil K. Warma
Opexa Therapeutics, Inc.
President & CEO
281-775-0600
nwarma@opexatherapeutics.com
or
Institutional Investors:
Carney Noensie
Burns McClellan
212-213-0006
cnoensie@burnsmc.com
Copyright Business Wire 2012
Cyveillance, Still Leaving a Trail–Who Pays These Guys?
If I was paying money to monitor those who I may perceive as a threat (my husband does have Multiple Sclerosis and I am a health care activist and I guess that does make us scary threatening to some) I would hope that those I pay have some, what’s the word–subtlety.
From my handy Statcounter:
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For those of you not familiar with Cyveillance, they monitor websites; more details below from Wikipedia. They were a big visitor to Illness and Insurance Hell all during 2009 when President Obama was trying to pass health care reform.
From Wikipedia:
Cyveillance
Cyveillance, founded in 1997, is a private Internet-monitoring company based in Arlington, Virginia and provides an intelligence-led approach to security. The company’s subscription-based product, the Cyveillance Intelligence Center, is a hosted solution. Companies hire Cyveillance to monitor for Internet risks such as: Information leaks; Phishing and malware attacks and other online fraud schemes; Sale of stolen credit and debit card numbers; Threats to executives and events; Counterfeiting; and Trademark and brand abuse.
Cyveillance was bought in May 2009 by the UK firm QinetiQ, for an initial cash consideration of $40 million.[1] Cyveillance’s clients include the pharmaceutical industry and entities within the entertainment industry, particularly music and movie concerns, specifically, the RIAA and MPAA. Cyveillance runs scans which attempt to gain unauthorized access to P2P networks, Web servers, IRC servers, FTP servers, and mail servers, searching for mp3 audio files and movie titles. After running the scan, the site scanned is archived, and the information sold to the RIAA and/or MPAA.[citation needed]
And more about Cyveillance directly from their website here.
Your Money Lost; MetLife’s Long-Term Disability Scam in MetLife v Glenn
We write a lot here about group long term disability policies and what bogus products they are. So much so, it is financially unsound to trust these policies to take care of you should you become injured, sick or disabled.
A particularly egregious example of just how worthless group policies are is seen in a case that made it to the Supreme Court (please note how the dissents fall in strict Citizen’s United lines) in Metropolitan Life Insurance Company v Glenn where MetLife was both the insurer and administrator of the group plan that insured Ms. Glenn–a huge conflict of interest. It’s like having the fox watch the hen house.
MetLife sought Supreme Court review because of an earlier decision that forced MetLife to pay Ms. Glenn her benefits. MetLife spent a lot of money on this because of the precedent it set: An insurance company had to make good on a long-term disability claim and pay benefits to a person who became too disabled to work full time.
Ms. Glenn was a Sears employee who was diagnosed with severe dilated cardiomyopathy. She had dutifully paid her premiums and now she needed to use her benefits since she was too sick to work due to heart failure.
MetLife directed Ms. Glenn to a law firm to make sure she got Social Security so they could off-set her benefits. CIGNA and all the other insurers do the same. See my earlier blog postings at Illness and Insurance Hell. Just follow the money.
MetLife received the bulk of those retroactive benefits due to offsets written into the language of the policies themselves. These group disability policies are, in essence, bogus products; don’t waste your money.
After the first two years of Ms. Glenn’s policy, MetLife decided to reverse themselves:
On one hand, MetLife forced Ms. Glenn to apply for Social Security benefits, sent her to a law firm to help receive them and took taxpayer dollars to offset the plan she paid premiums for BUT when it came time to continue paying those benefits after the first two years, MetLife “itself had to determine whether she could work, in order to establish eligibility for extended plan benefits, it found her capable of doing sedentary work and denied her the benefits.”
This was what the Social Security agency said as well, but with help from the law firm they sent Ms. Glenn to, MetLife pushed, and received, tax payer dollars in the form of Social Security dollars. They burden the Social Security system.
The Supreme Court found this questionable as well and said so:
MetLife also did the same thing CIGNA did to us, namely pick out information that bolstered their point of view of the reality of my husband’s disease, Multiple Sclerosis:
If you are wondering why this happens, it’s simply due to corporate greed and money–lots of money. These group policies are huge money makers for the large health insurance companies and they rake in billions in profits each year from them. Paying out claims to people with Multiple Sclerosis is not what they want to do–their interests lie in fattening the bottom line.
As financial tools, they are worthless and a waste of your hard-earned dollars. You have alternatives such as private policies. Save your money and look elsewhere. And if you think these policies need to be better regulated or ERISA should be removed or rewritten as law, write your members of Congress. That’s what we pay them for.
Your health and well-being do not matter to large corporate entities no matter how much they try to spin it otherwise. See AHIP.
Quotes from the GOP Leader of the Senate, Mitch McConnell
“Throughout the debate, Senate Republicans have argued that this misguided law represents an unprecedented and unconstitutional expansion of the federal government into the daily lives of every American. Most Americans agree. In both public surveys and at the ballot box, Americans have rejected the law’s mandate that they must buy government-approved health insurance, and I hope the Supreme Court will do the same.”
Government approved health insurance? In 2014 it will be a mandate to buy insurance from private companies who pay to finance your campaigns, Senator. The government has given a gift to the private companies with this mandate rather than setting up a government run program, like Medicare, to give them some competition. What’s the solution–private health insurance or a government run program like Medicare for Everyone?
MCCONNELL: Well, it doesn’t make any difference frankly whether you opt-in or you opt-out, it’s still a government plan. You know, Medicaid, the program for the poor now, states can opt-out of that, but none of them have. I think if you have any kind of government insurance program, you’re going to be stuck with it and it will lead us in the direction of the European style, you know, sort of British-style, single payer, government run system. And those systems are known for delays, denial of care and, you know, if your particular malady doesn’t fit the government regulation, you don’t get the medication.
MILLER: Right.
MCCONNELL: And it may cost you your life. I mean, we don’t want to go down that path.
No, of course there are no delays or denial of care now, Senator McConnell because we only have 45,000 Americans die each year due to lack of health insurance, so a public program that would cover everyone would lead to–coverage and health care?
Americans..”don’t want is a Washington takeover of health care along the lines of what we’ve already seen with banks, insurance companies, and the auto industry. Americans don’t want a government-run system that puts bureaucrats between patients and doctors.”
The government has taken over the banks? The insurance companies? The auto industry? When did that happen? The only bureaucrats standing between patients and their doctors work for CIGNA, UnitedHealth, WellPoint and all the other health insurance companies.
Senator McConnell enjoys some of the finest government subsidized health care in the world thanks to the United States taxpayers, the Federal Employee Health Benefits Program. Ask the Senator from Kentucky if we should extend that government program to all United States citizens.
Your Money Lost: Group Long Term Disability Insurance Policies
Did you know your tax dollars are used to subsidize private health insurance companies?
If you are unfamiliar with Social Security Disability Insurance, here is an excellent primer put out by AARP. SSDI provides protection specifically to qualified U.S. citizens who become disabled and lose their ability to earn an income. We all pay for this through our Social Security taxes. It’s one of the many benefits of being a United States citizen.
When my husband was employed at Fidelity Investments he had a group disability insurance policy with CIGNA. He even purchased extra coverage–to protect our family with 80% of Paul’s income just in case something happened.
But that money was ill-spent as CIGNA did everything in their power to deny coverage to a man with Progressive-Relapsing Multiple Sclerosis. This is not unusual behavior for any private insurance company. In fact, it’s exactly what they do.
But first, you must apply for Social Security Disability Insurance.
When Paul was mid-way through with short term disability and it appeared he was getting progressively worse and not better, CIGNA telephoned us to inform us that they were getting his file ready for long term disability. Great, we thought, they are helping us! Isn’t that what they collect a premium each month for? The answer to that is, no. They collect a premium each month to make money. Keeping that money and not paying it out in claims helps their bottom line.
From the Group Life Market Survey 2009 outlining the sales in disability insurance, you can see group sales disability totaled $1.3 billion at mid-year, with 27 private insurance companies covering 95% of the total market.
After CIGNA denied Paul’s benefits, they telephoned us again. “You must apply for Social Security benefits and send us proof of your application or your long term application with us will be invalid.”
Why does a private insurance corporation demand that you apply for government benefits?
Money, that’s why. If you qualify and receive Social Security Disability Insurance then your insurance company will off-set the amount of money they contractually owe you by the amount of money you will receive from the government. For example, if Paul’s CIGNA policy was to have paid him $5,000 a month and SSDI would give him $2,000 a month, then CIGNA would subtract that amount and only give Paul $3,000 a month. Your tax dollars are used to subsidize private corporations.
Your money is used to fatten the bottom lines of Aetna, AIG Benefit Solutions (that’s how much now in government money for AIG?) CIGNA, Guardian Life, Hartford Life, Mutual of Omaha, Northwest Mutual, Prudential, Sun Life, UnitedHealthcare, Unum and Wellpoint, to name but a few.
Why pay a premium at all?
An entire industry has been set-up surrounding group disability plans to help private insurers NOT pay the claim.
For example, every year the American Conference Institute (one among many) has a yearly event titled, “Litigating Disability Insurance Claims.” Please click the link and read the brochure–it is so very eye-opening. From the brochure, here is what the insurance companies, their general counsels, federal judges (they are the very same federal judges who will decide your disability case!) and doctors will discuss at the above-mentioned conference, emphasis in blue is mine:
- Whether the medical record is reliable: Whether the treating physician is biased and favors the patient
- Providing the credentials of the IME’s (Independent Medical Examiner–hired by insurance company): Identifying what is relevant; Highlighting the appropriate credentials; Ways to appropriately critique the credentials of the IME: what to look for and ways to address the inadequacies; Whether specialized medical knowledge is a necessary component of the IME’s credentials (in the case of Multiple Sclerosis, patients are seen and treated by neurologists, the IME who looked at Paul’s written medical records was not a neurologist and first letter of denial was written by an RN and not a doctor)
- Rotating vendors to avoid the appearance of bias and to ensure an independent review of the claim
- The denial factor: How many claims were reviewed and denied?; Whether repetitive denial leads to an appearance of bias; Ways to utilize claim denial information
- Whether the claimant is constrained by financial pressures and returns to work disabled
The last one is of particular interest to me because that is exactly what happened to this family. This family, faced with zero income as Paul had been the sole bread winner for most of our married lives, had to return to work at Fidelity Investments, disabled. This is something the insurance company counts on to help bolster their claim that you are not disabled.
Medical evidence that you are disabled will not prevail.
This conference, and others like it, focus on how to prevent paying a claim, and it does not matter if the claim is legitimate, what matters is the corporate bottom line. The American Conference Institute also has another conference dedicated to defending ERISA claims attended by more federal judges–the very same ones who will hear your ERISA disability case.
Your premium dollars, the ones you work so very hard to pay each month to your private insurance carrier, are not spent on paying a claim should you wake up one day with cancer, MS or become injured in an accident. No. Those hard earned dollars are spent on figuring out how not to pay you. And then, they use your tax dollars to reduce the amount they owe you.
United States taxpayers, it’s time to say enough. Group long-term disability policies are bogus products. They should either be highly regulated or not allowed to be sold at all, as the poorly written policies and the attendant machines put in place by the insurance companies to deny all claims, make the products fraudulent and worthless.
Links:
CIGNA written brochure for brokers about their long term disability product.
Dell and Schaefer, a law firm, discussing CIGNA including the LINA settlement in California.
The 11 Federal Judges Attending the 2011 Defending and Managing ERISA Litigation Conference.
The American Conference Institute assembles a yearly “defending against ERISA claims” conference usually held in New York City. This year’s conference is at the New York Marriott Downtown.
If you have Multiple Sclerosis or any other disease that forced you to fight for your benefits because companies like CIGNA lied (not hyperbole) to prevent your claim, then you know all about ERISA or the Employment and Retirement Income Security Act of 1974. Unfortunately, ERISA has had negative consequences. A full explanation, written by an ERISA expert, can be found here.
But you may not know that the very same federal judges who may hear your case attend these conferences where they help coach insurance companies, plan providers and other attorneys on how to defend against ERISA claims. In other words, how to make sure a company like CIGNA doesn’t have to fulfill their contractual obligations and pay your claim. From the conference brochure:
An ERISA Moot Court: Featuring top defense attorneys arguing some of the hottest and most common issues facing ERISA practitioners today, panels of renowned ERISA jurists will critique arguments, question our litigators and help all attendees understand how to successfully convey their positions to the court.
The federal judges, the ones deciding your cases, are going to going to participate in a moot court to help defend against ERISA claims? How does that square with remaining impartial as part of the judges’s code of conduct? And our favorite here at the MS Activism Foundation:
Breaking Up Is Hard to Do: A Focus on Severance Plan Litigation including Triggering Events, COBRA Hang-Ups, and the Other Litigation Issues that Arise in Separation Situations.
CIGNA had a big loss this year in CIGNA v. Amara, even though they are spinning it otherwise, so of course, CIGNA’s senior counsel, Christina McNally will be in attendance at the conference.
Fidelity Investments, my husband’s former employer, is listed on the last page as being in attendance as well. I could not find a name though. Last year it was their very own senior counsel, (and Paul’s fellow Boston College alum) Laura Tholen.
Here are the names and districts of all the federal judges who are attending this year’s conference. And here is a link to the PDF of the 2011 conference. If you are fighting for your claim, and see your judge, send them a letter. Tell them that you know what they’re doing and that it certainly does not appear impartial.
Here are the Codes of Conduct for United States Judges and be sure to ask about CANON 3: A JUDGE SHOULD PERFORM THE DUTIES OF THE OFFICE FAIRLY, IMPARTIALLY AND DILIGENTLY.
Hon. Daniel E. Knowles, III U.S. Dist. Ct., E.D. La.
Hon. Morton Denlow U.S. Dist. Ct., N.D. Ill.
Hon. Matthew Kennelly U.S. Dist. Ct., N.D. Ill.
Hon. William S. Duffey, Jr. U.S. Dist. Ct., N.D. Ga.
Hon. Viktor Pohorelsky U.S. Dist. Ct., E.D.N.Y.
Fernando J. Gaitan, Jr. U.S. Dist. Ct., W.D. Mo.
Hon. Timothy C. Batten, Sr.U.S. Dist. Ct., N.D. Ga.
Hon. Robert Jonker U.S. Dist. Ct., W.D. Mo. (I think the American Conference Institute meant MI not MO.)
Hon. Richard G. Stearns U.S. Dist. Ct., D. Mass.
Associated Press Reporting Lemtrada (campath) Missing a Goal in Trials.
Associated Press, 07.11.11, 11:29 AM EDT 
Sanofi also listed the side-effects as headache, rash, fever, nausea, flushing, hives, and chills, leaving out the deaths reported in the clinical trials.
I also was very wary when I read the study and they were touting the drug as being able to prevent disability outright. It was even reported that it may reverse brain damage from MS. Nothing short of a miracle, right? Or a selling point worthy of $20.1 billion?
Bits and Pieces; Updates on Campath/Lemtrada, Health Care Reform and the National MS Society.
If you have been following this blog because you or a family member has Multiple Sclerosis you may know about the Sanofi takeover of Genzyme. Alternately, if you are one the many pharmaceuticals or investors or PR and advertising firms that visit us, you already do know that Sanofi completed the $20.1 billion buyout of Genzyme.
Which brings us to Campath (acquired from Bayer by Genzyme) now known, or trying to be known, as Lemtrada. We have written about it here because of the shameful desire to increase the price of a relatively inexpensive cancer treatment to $60,000 per year for Multiple Sclerosis treatment.
It is NOT YET APPROVED for use by the FDA. Campath/Lemtrada is still in clinical trials. Here is a link to the latest in their Clinical Trials.
At one point, Genzyme was giving Campath away for compassionate use in cancer patients. This was done by Genzyme to erase the yearly sales figures so that when the same drug rolls out (when approved) the $60,000 per year price sticker for Multiple Sclerosis won’t have a sales comparison number–of something much, much cheaper. Redefines the whole meaning of compassion, doesn’t it?
______________________________________________________
Health Care Reform:
While the Affordable Care Act is not yet a law–we still have until 2014 for the whole thing to go
into effect–the GOP is back to using their favorite catch phrase, “death panels.”
Here is a link to an article in Talking Points Memo about Rep. Phil Gingrey (R-GA) raising the dirty spectre of death panels and rationing yet again. Just an FYI, Rep. Gingrey voted to abolish Medicare. I think the good doctor should know better than to espouse what he does, but here’s the quote:
We’re the only democratic and industrialized nation in the world without a universal plan; a plan where anyone can buy into a risk pool and get themselves covered no matter what. We all get sick, it’s part of the human condition. It’s how we treat ourselves that defines our society.
My husband now, having been without insurance for six months, can finally apply to the new high risk pool–thanks to the Affordable Care Act. We ask the representative from Georgia, “What should we do, Dr. Gingrey?” Repeal the health care law like you and every member of the GOP want to do so that my husband (and all other Americans like him) will go without health insurance and health care?
Crying tort reform over and over, as Dr. Gingrey does, isn’t going to fix the system, but considering that the good doctor has himself been sued for malpractice several times, it becomes obvious why he repeats this so often. And why he’s introduced legislation into Congress that would limit damages for pain and suffering from malpractice cases. See H.R. 5 of the 112th Congress.
Dr. Gingrey has this to say about health care reform:
Government takeover of health care? A proven lie.
If government is so bad, why does Dr. Gingrey want to use government to sharply cut medical malpractice awards? Won’t the free market just sort things out on its own?
But if Dr. Gingrey is speaking about the government creation of a high risk pool to help my husband and all Americans with pre-existing conditions get access to health care by purchasing insurance that will cover them, then I suggest he re-read his Hippocratic Oath.
As for tax burdens and small businesses, small businesses love the Affordable Care Act because they get tax breaks. And read more here, from Fox News.
Are we being threatened by rising costs? Yes. Why? Because Dr. Gingrey and his GOP ilk refuse to expand Medicare to Everyone. A national health plan that would compete for customers may inspire the private health insurers to actually produce a good product. Competition does that. As it is now, the private health insurers have zero competition.
______________________________________________________
Now onto the National Multiple Sclerosis Society:
We got a flyer from the National MS Society the other day about their teleconference series that, “is designed to support individuals with MS through the continuum of their work experiences; from staying employed, to retraining and on to post-employment options. Understanding how to access vital resources will help individuals make the best choices through any stage of their workforce journey.”
With all the money the National MS Society takes in (and spends), this piece of writing just sent me over the edge as it purports to say
something without saying anything at all. They paid for that with your donation dollars. And it gets worse:
Applying Through Your Employer’s Long Term Disability Benefits When MS Progresses
Featured speaker Lisa Kantor, LLP from Kantor and Kantor will share her expertise as an advocate who has successfully represented people in Employment Retirement Income Security Act (ERISA) benefit claims for over 18 years. If you have MS and Long Term Disability Insurance through your employer, you will want to know how to apply for and access these vital benefits.
Let me just begin by saying that the whole reason I’m here writing this, the whole reason this Foundation exists is because of the way my husband was treated both by his Long Term Disability insurance carrier, CIGNA.
He was denied his benefits by CIGNA. Twice. We had no where to turn for help, including the MS Society at the time.
This sort of teleconference series makes the National MS Society look good, but doesn’t really help. And with all the money they have, imagine what they could do. They could start by lobbying Congress to fix ERISA–that would go a long way in helping not just those with MS but all who have been denied their benefits or who have been mistreated by their health insurer.
Listening to Ms. Kantor may be helpful, she may even gain a few clients from this teleconference, but she can’t help you “apply for and access these vital benefits.” She simply cannot and that has nothing to do with Ms. Kantor.
See, one cannot actually access their long term disability benefits. I wrote extensively about that over at Illness and Insurance Hell.
Your insurance carrier starts the process while you are still on short-term disability; they will insist you apply for Social Security benefits and prove that you have been through that process or else they’ll deny your claim. They will even offer you help with one of their attorneys to make sure you go through the Social Security process.
To make matters even worse, they will obfuscate the truth (that’s called lying) in the face of medical evidence; they make things up. And when they are threatened with legal action, they send photographers (bad ones I’d like to add) to your house to photograph you and your family. My husband has lesions on his brain and spinal cord, could the guy with the camera, snapping away at us, somehow disprove that?
Then, after all of that, they all attend conferences with federal judges (among others) to figure out how to defend against ERISA claims. Anything not to pay a claim.
Which brings me back to the Affordable Care Act, the Ryan plan to abolish Medicare and the GOP still trying to get rid of health care reform.
I ask this: If the GOP succeeds in repealing health care (doubtful) but say they do, then the provisions in the law that help people, that stop lifetime caps, give seniors free preventative care, that fill the Medicare donut hole, that stops insurers from retroactively cancelling your plan, that gives Medicare drug discounts–if the GOP stops all this then what good is that $8,000 Ryan Voucher?
MS Activism 