Frank Sinatra and Doris Day are an unlikely couple in the 1954 romantic musical drama Young at Heart. Sinatra is the cynical Barney Sloan who falls in love with the sunny Laurie Tuttle, played by Day. They wed, but Barney's dark outlook on life continues, eventually leading him to attempt suicide in his friend's car. In the dramatic final scenes of the film, a depressed and dying Barney is healed - body and soul - through music, medicine, and Laurie's love.
I created a contemporary version of this story. The Tones, a musician and a housewife, have no health insurance. Barney and Laurie are wildly happy until Barney is in a terrible car accident. He almost dies because the hospital demands cash before treating him. He survives, but the Tones lose everything. In a bad economy, they must work as live-ins for room and board and get second jobs to pay the medical bills. Barney becomes a bar entertainer and Laurie becomes a prostitute.
Scary tales can come true. It can happen to you,
'Cuz they've got no heart.
Along with the movie today, folks, will be a few bonuses. I hope you enjoy the show!
NOTE: A tip of the hat to Eirene for the diary Price of admission: $105,000 and to rjones2818 for the diary America's Pay-or-Die Health Care System, both excellent Daily Kos diaries covering the same topic I address in my "documentary." I am writing about it again because I feel the story is important enough to warrant further exposure and because I am covering it in a completely different way.
DOCUMENTARY
Last month, the Wall Street Journal published Cash Before Chemo: Hospitals Get Tough, which revealed shocking collection strategies being employed by both profit and non-profit hospitals. Much of the report focused on the experiences of the Texas couple Sam and Lisa Kelly. (emphasis mine)
When Lisa Kelly learned she had leukemia in late 2006, her doctor advised her to seek urgent care at M.D. Anderson Cancer Center in Houston. But the nonprofit hospital refused to accept Mrs. Kelly's limited insurance. It asked for $105,000 in cash before it would admit her. ...Ms. Kelly says she told M.D. Anderson's representatives that she had some money to pay for treatment, but couldn't get all the cash they asked for that day. "Are they going to send me home?" she recalls thinking. "Am I going to die?"
Hospitals are adopting a policy to improve their finances: making medical care contingent on upfront payments. ...Hospitals say they have turned to the practice because of a spike in patients who don't pay their bills. ...The bad debt is driven by a larger number of Americans who are uninsured or who don't have enough insurance to cover medical costs if catastrophe strikes. Even among those with adequate insurance, deductibles and co-payments are growing so big that insured patients also have trouble paying hospitals.
Hospitals would rather discuss costs with patients upfront, he says. "After, when it's an ugly surprise or becomes contentious, it doesn't work for anybody." ...Asking patients to pay after they've received treatment is "like asking someone to pay for the car after they've driven off the lot." ..."The time that the patient is most receptive is before the care is delivered."
[Anderson] says it acted appropriately in Mrs. Kelly's case because she wasn't indigent, but underinsured. ...Federal law requires hospitals to treat emergencies, such as heart attacks or injuries from accidents. But the law doesn't cover conditions that aren't immediately life-threatening.
I guess that depends on the definition of "immediately life-threatening." Lisa has acute leukemia, "a cancer of the blood that can quickly turn fatal" according to the WSJ article.
When Mrs. Kelly called M.D. Anderson to make an appointment, the hospital told her it wouldn't accept her insurance, a type called limited-benefit. An estimated one million Americans have limited- benefit plans. Usually less expensive than traditional plans, such insurance is popular among people like Mrs. Kelly who don't have health insurance through an employer. ...A spokeswoman for UnitedHealth, one of the country's largest marketers of limited-benefit plans, says the plan is "meant to be a bridge or a gap filler."
Obviously, as the economy declines and lay-offs continue, more and more people will be losing their employer-based medical coverage and will not be able to replace it with similar coverage - or at all. Those who have pre-existing conditions will be in the worst positions, of course.
M.D. Anderson viewed Mrs. Kelly as uninsured and told her she could get an appointment only if she brought a certified check for $45,000. ...Mr. Kelly arranged to borrow the money from his father's trust, which was in probate proceedings. ...The Kellys arrived at M.D. Anderson with a check for $45,000 on Dec. 6, 2006. After having blood drawn and a bone-marrow biopsy, the hospital oncologist wanted to admit Mrs. Kelly right away. But the hospital demanded an additional $60,000 on the spot. It told her the $45,000 had paid for the lab tests, and it needed the additional cash as a down payment for her actual treatment. In the hospital business office, Mrs. Kelly says she was crying, exhausted and confused. The hospital eventually lowered its demand to $30,000. Mr. Kelly lost his cool. "What part don't you understand?" he recalls saying. "We don't have any more money today. Are you going to admit her or not?" Mrs. Kelly was granted an "override" and admitted at 7 p.m.
The nightmare wasn't over yet.
Chemotherapy would continue for more than a year, as would requests for upfront payments. At times, she arrived at the hospital and learned her appointment was "blocked." That meant she needed to go to the business office first and make a payment. ...One day, Mrs. Kelly says, nurses wouldn't change the chemotherapy bag in her pump until her husband made a new payment. She says she sat for an hour hooked up to a pump that beeped that it was out of medicine, until he returned with proof of payment. ...Once, Mrs. Kelly says she was on an exam table awaiting her doctor, when he walked in with a representative from the business office. After arguing about money, she says the representative suggested moving her to another facility.
Since February of this year, Mrs. Kelly has been covered by a new and better insurance plan. Given her history, it's hard to imagine how much she is paying for that - and how many months she had to pay for no benefits before the pre-existing condition clause expired.
But she is still personally responsible for $145,155.65 in bills incurred before February. She is paying $2,000 a month toward those. Last week, she learned that after being in remission for more than a year, her leukemia has returned.
Some might think it's necessary for hospitals, particularly non-profits, to use these tactics to protect themselves and the communities they treat. Apparently not.
Tenet Healthcare and HCA, two big, for-profit hospital chains, say they have also been asking patients for upfront payments before admitting them. While the practice has received little notice, some patient advocates and health-care experts find it harder to justify at nonprofit hospitals, given their benevolent mission and improving financial fortunes. An Ohio State University study found net income per bed nearly tripled at nonprofit hospitals to $146,273 in 2005 from $50,669 in 2000. According to the American Hospital Directory, 77% of nonprofit hospitals are in the black, compared with 61% of for-profit hospitals. Nonprofit hospitals are exempt from taxes and are supposed to channel the income they generate back into their operations. Many have used their growing surpluses to reward their executives with rich pay packages, build new wings and accumulate large cash reserves. ...M.D. Anderson, which is part of the University of Texas, is a nonprofit institution exempt from taxes. In 2007, it recorded net income of $310 million, bringing its cash, investments and endowment to nearly $1.9 billion.
This is a tale of pay or die that recurs again and again all over our country and only in our country in the entire western world. ...Imagine anything like Mrs. Kelly's predicament and pressures occurring in Canada, Belgium, Germany, Italy, France, Switzerland, Holland, England or any other western country. It would never happen. ...When a friend showed the Journal's article to a Dutch visitor, the latter blurted in anger - "you are a nation of sheep." Not a very flattering description of "the land of the free, home of the brave." Someday, soon maybe, Americans will finally band together and say "enough already," we're going for full Medicare for all- without loopholes for corporate profiteers and purveyors of waste and fraud.
CARTOON
SHORT SUBJECT
This month, I first heard from a few people I know the idea that the way to eliminate unemployment, low wages, entitlement programs, the housing crisis, and health care problems is to make prostitution legal and then to mandate free health care for prostitutes! At first, I thought it was some sort of joke, but it wasn't. Putting aside the question of whether prostitution should be legalized at all, what kind of country have we become that anyone would advocate forcing jobless, homeless, sick, disabled, poor, and/or elderly people into the world's oldest profession?
The concepts of a $100,000 "cover charge" for hospital admission and "government as pimp" are just a bit too much for me!
A parody is born.
It's sort of like this movie. But, not quite...
FEATURE PRESENTATION
******************** Got No Heart: A Modern Medical Musical Tragedy ********************
The wholesome-looking sisters Goldie and Frannie nee Sluttle are happily doing dishes in the kitchen when the phone rings. They rush into the foyer to join Alex Shirk and Aunt Hussie as they listen in on Big Daddy Gregory Sluttle's conversation. (NOTE: In the dueling dialogue that follows below, the original lines are on the left)
Oh no! It seems that Robert Weary, Frannie's husband, is in the hospital!
Oh no! The Wearys don't have medical insurance! On the way to the ER, Frannie is as worried about the medical bills as she is about Bob. Always-optimistic, the more worldly Big Sista Goldie explains to Frannie just how she can cover those expenses.
Oh no! In the hall, Big Daddy reveals there's been a mix-up! It was really Barney Tone in the car.
Oh no! The Tones don't have health coverage either! Goldie rushes into Barney's room. This can't be good.
Oh no! Goldie is going to have a baby - without insurance! What was she thinking?
Oh no! Barney made it, but the Tones are bankrupt! They work at the Riches mansion for room and board. To pay off the medical bills, Barney performs for tips at the local bar and Goldie moonlights at the local cathouse. Friends and family sneak into the Rich house to gather around the piano and hear Barney's new song. Goldie enters holding the baby.
Oh no! Goldie is starting to feel guilty about her night shift job! Barney tries to cheer her up with his music.
(You, My Love was written by Mack Gordon and Jimmy Van Heusen. You'll find the original lyrics here and you can listen to Sinatra singing it while you read my lyrics if you right click and open a new tab here.)
Due, My Love
My bill is overdue, my love.
Now pay or they will sue, my love.
Just strut into that underworld.
Your clothes divine, your hair all curled.
Yes and because it's due, my love.
The turning of the screw, my love.
You're my bread-winning tart.
It's not really sinning, love.
No need to feel blue,
My love!
Off to a winning start,
It's just the beginning, love.
So much remains due,
My love!
Oh no! Grampa Big Daddy has a stinky surprise for Baby Right Wing! (And, baby has a stinky one for Gramps, too.) The gang might be smiling now, but this adaptation is going to end on a sour note...
Oh no! Barney can't stand crybabies, so he breaks into song one last time to distract everyone. But, the song he chooses just makes things worse!
(The theme song Young at Heart was written by Carolyn Leigh and Johnny Richards. As before, the original lyrics are here and you can hear Sinatra's lovely rendition here.)
Got No Heart
Scary tales can come true, it can happen to you,
'Cuz they've got no heart.
It's too hard to be kind, they are narrow of mind,
'Cuz they've got no heart.
They will go to extremes with impossible schemes.
They don't care if your dreams fall apart at the seams.
And life gets more expensive with each passing day.
The bill is either in your hand, or on its way.
From the day of your birth, they'll steal all that you're worth
'Cuz they've got no heart.
If it's rich that you are, it's much better by far,
'Cuz they've got no heart.
And if you should survive to 105,
Look at all they derive from your being alive!
The bill from the "health mart," tearing you apart.
They don't give a damn because they've got no heart.
[Musical interlude]
And if you should survive to 105,
Look at all they derive from your being alive!
The bill from the "health mart," tearing you apart.
They don't give a damn because they've got no heart.
THE END
You can learn more about the movie Young at Heart at Wikipediaand at IMDB. There's also more on the theme song at Wikipedia.
What is health justice? How are health & human rights fiercely connected to the wellness of our neighborhoods? How do we reframe policy debates? How do we continue dreaming and building instead of just reacting & surviving? And how do we support each other in our healing?
Cure This is an online space for storytelling, discussion, reflection and building around healing justice. Create an account to write a diary or comment. Questions or thoughts: lotusfeet [at] hotmail [dot] com
News: CureThis was part of an exhibit in Chicago: "Visual resistance in feminist health movements, 1969-2009" [link]
