Monday, November 04, 2013


The Wall Street Journal has published a health care op-ed that's getting a great deal of attention. It's by a California woman named Edie Littlefield Sundby, who's been fighting stage-4 gallbladder cancer for seven years and now has lost a health insurance plan she wanted to keep. Sundby says that, thanks to President Obama, there's no affordable alternative that gives her access to her doctors:
My choice is to get coverage through the government health exchange and lose access to my cancer doctors, or pay much more for insurance outside the exchange (the quotes average 40% to 50% more) for the privilege of starting over with an unfamiliar insurance company and impaired benefits....

Two things have been essential in my fight to survive stage-4 cancer. The first are doctors and health teams in California and Texas: at the medical center of the University of California, San Diego, and its Moores Cancer Center; Stanford University's Cancer Institute; and the M.D. Anderson Cancer Center in Houston.

The second element essential to my fight is a United Healthcare PPO (preferred provider organization) health-insurance policy.

Since March 2007 United Healthcare has paid $1.2 million to help keep me alive, and it has never once questioned any treatment or procedure recommended by my medical team.
Sundby has a PPO policy? That's curious, because last November, when she was profiled in AARP The Magazine, we were told the following (emphasis added):
In July 2007, [a surgeon] cut a 14-inch incision from Edie's breast to her pelvic bone and removed her gallbladder, a substantial portion of her liver and several lymph nodes....
For nearly four more years -- while technically in remission -- Edie continued to receive chemotherapy (79 treatments in total, 836,000 milligrams of chemicals pumped into her body). She was able to do this in part thanks to her insurance, a catastrophic medical policy that covered 80 percent of the cost of her treatment. (Being self-employed, she and Dale had opted for this plan, which is generally less expensive than overall health coverage.) Even so, the 20 percent out-of-pocket copayments amounted to tens of thousands of dollars.
Was this story mistaken while the Journal op-ed is correct? Or did Sundby switch plans only in the past two years, while implying in the op-ed that she was covered by a PPO for the past seven?

I'd also like to point out that Sundby and her husband, Dale, aren't exactly typical Americans struggling with a health crisis while punching a clock and hoping that an inadequate paycheck will stretch to the next payday:
Dale ended up heading IBM's Palo Alto office just as the Silicon Valley was taking off, and Edie accepted an executive position at AT&T in San Francisco. But in 1984 they decided to leave their corporate jobs and venture out as software entrepreneurs, settling in San Diego, where, in 1988, they had their twin girls. They experienced huge business successes, as well as some failures, and never lost their drive. In 2007, with Whitney in college and Stefanie taking a year off, they were optimistic about their next project: developing a financial-services platform using software developers in Ukraine.
You can read about some of Dale Sundby's Clinton-era dot-com ventures, and the millions of dollars of venture capital he burned through, here and here.

Many Americans, hit with a situation like this, are already stretching their income to the breaking point. The AARP story tells us that Edie Sundby first experienced symptoms when "she'd just returned to Southern California from Chennai, India, where she and one of her identical-twin daughters, Stefanie, then 18, had spent five weeks volunteering at an elementary school." (Stefanie, by the way, was "wrapping up a neuroscience degree at Stanford" -- not an inexpensive school -- at the time the story was published.) And Edie's husband, upon learning of her diagnosis,
ultimately decided to walk away from the Ukraine project, knowing he couldn't commit while assisting Edie in her battle. The results, financially, were "traumatic," Dale says. "But we are, as a family, willing to go to the end, to spend whatever it takes. That's what vows and commitments are all about."

Whenever Edie suffered a setback, she took what she calls "a spirit quest" into the wilderness. Weary from chemo in the summer of 2009, she and Dale traveled by camper van through national parks in the West. "The wilderness helps me forget everything," Edie explains. "I don't think about cancer; I feel healthy there." Twice more they headed out on camping trips, the last time in 2011 when the cancer returned.
In this country, it's rare that a husband and wife can just choose to clear time from work while one of them battles cancer. It's not always possible even for the patient to stop working. Edie, however, just rejuvenates her spirit by traveling as far afield as Alaska and Fiji, as she explains in this post at the "Well" blog of The New York Times.

She never intended to stop working however, as the AARP story noted:
Early in 2013 she hopes to launch Skin Jolie, a beauty line she's been developing.
I bring all this up not to criticize the Sundbys for taking advantage of a certain amount of material wealth, but to point out that Edie Sundby is, in all probability, not like you, and not like the people you know who sometimes have to choose between medicine and food, and whom the Affordable Care Act was designed to help.


Greg said...

But if it's the Wall Street Journal, we can surmise that the probable subtext is Sundby is someone you should be like, if you're not a goddamn taker.

Glennis said...

One also has to wonder why, if they have so much income, they chose to get this rather lousy policy. Could it be because her pre-existing condition made it the only policy available? Well, that's no longer the case now, thanks to the ACA.

Leah said...

The reason all this is happening to the Sundbys, which appears to go unmentioned in the op ed, is that United has chosen to absent itself and it's health insurance policies from the California individual marketplace, where it has been struggling to stay competitive, before the ACA went into effect; I think even before it had passed.

I know something about this because a doctor I know has several patients whose individual policies have been cancelled; he recommends Igor Volsky's run down of the entire situation at Think Progress.

Victor said...

Not exactly like my neighbor's family, is it?
He's a young, early-to-mid 30-something iron-worker, and he and his Mrs. have 3 young daughters.

Is the WSJ trying to take a page from the NY Times, trying to highlight the problems of the NEARLY rich - the people just under the top 1-2%?

Better to find people who can't afford the previous status quo - but, that's much too Liberal, isn't it?

Better to tell sad stories about people who can do whatever they want to do - but are too foockin' cheap to do it!

aimai said...

I don't understand why she's complaining--she can pay out of pocket for her doctors, can't she, just like Rush Limbaugh proposed we all do. Surely that will bring down the cost of her care and she can keep seeing the doctors she likes. She and her husband can pay her cancer doctors in chickens or cash. They don't *need* a health insurance company at all, do they? A million dollars or 2 million dollars is not, in fact, that much to people like this. They can sell one of their overpriced california houses and still be able to afford the treatment they like.

I also don't really understand why no other insurance company will cover her to see those doctors. Just because United won't do it doesn't mean those doctors have vanished.

If it is in fact the case that United is not covering people in California how is this Obama's fault. Do people like this imagine that forcing United to maintain coverage of her wouldn't be government interference?

Building Magic said...

Yes. Smear the victims to provide cover for the liar in chief.

Steve M. said...

So you're saying the AARP profile of her is in error? Or the blog posts she wrote for The New York Times are inaccurate? I'm smearing her with her own words?

aimai said...

How is she a victim? Her company didn't cancel her policy because it didn't meet the ACA standards they canceled it because they didn't want to keep paying for sick customers--they say so themselves. They are at a competitive disadvantage in California, they only have 8000 clients and the new ones they would get if they went on the exchange they say would cost too much because they would want to access health care. The company is withdrawing from the market for good old capitalist reasons. How was Obama supposed to prevent that in a capitalist system?

Examinator said...

WSJ and NYT are owned by Murdoch aren't they? Be in no doubt News (very) Limited outlets reflect *his* views.
Contrast this to the story (lack of from NEWS Ltd) from Aust where one of the youngest conservative federal politicians after 10 year in the senate lost his seat.(public scrutiny no longer an issue). He got a job as an international lawyer ($100K+?).

Within 8mths he left his wife and 2 children for a new girlfriend.
One of the children was severely (genetic) disabled (NB he [they were?] was opposed to abortion). Oh yes he cancelled the generous family private health insurance that was in his name! Thank What ever deity you like but Universal health system took over, albeit without their choice of specialist.

He refused her sufficient child maintenance and forcing her onto the street (public housing).

He refused to pay outstanding body corporate fees when he sold his 'luxury' apartment. And hid his earning in a complicated company web.

And there's more, the law made his Federal members pension $60k not part of his assets.
Regardless of how acrimonious the divorce was In my opinion this guy is a1st class asshole.

It was their opposition and publicly funded media who exposed him.

The NEWS Ltd coverage was very limited, when challenged, they claimed it was

A. a private matter and privacy is important. (see hacking scandal in UK and Murdoch's condemnation of subsequent investigations prosecutions “it a competitive world out there” and “everyone does it “type speech to staff of another Paper he owns.

B. it wasn't really news. Really? and boobs on page 3 of the UK “SUN” saving it from bankruptcy and making it the most popular daily tabloid; or FOX news is ? (let's be real the blond anchor woman and “moma bare” aren't there for their intellectual skills. Are you telling me that there aren't *better more competent * females who perhaps aren't as photogenic? It's *Lowest common * denominator pandering stuff. WSJ & NYT simply use the same formula in an expensive business suit.

PS go to a lunch time strip show catering see how many top name suits you can see...lots.

PPS guess which papers I avoid?

Steve M. said...

WSJ and NYT are owned by Murdoch aren't they?

WSJ yes, NYT no.

trizzlor said...

I'm glad you're pointing out the inconsistencies in this story, but the emphasis on Sundby's trips and her daughters college reeks a lot of snooping around at their granite counter-tops (in fact, Michelle Malkin also accused the Frosts of sending their children to a fancy school). The WSJ article is not intended to show that the Sundbys are an average household, but to show that Obama's promise of letting you keeping your insurance and your doctor has proven false. And that's basically the case. Obama chose a very opportunistic framing of the law; rather than explaining that health-care wouldn't change for most people and that the changes were net-positive, he pretended like it wouldn't change at all (unless you didn't like it). That's lazy and liberals should have called him on it. Instead, when it was brought up we just talked about how great it was going to be for most people, or how the people who would lose their plan would get a better one, without really ever admitting that Obama's claim was false. Now conservatives are finding actual example of people who were dropped and *are* unhappy, and we're just playing the same games.

Examinator said...

Oh dear, I've maligned NYT unfairly(?...its a news(?)paper though) !

I'll keep that in mind and actually read the NYT in my daily news mash up.

aimai said...

Trizzlor's argument is a flat out lie--how do you like your own sauce. This woman was not forced to give up her doctors by the ACA at all. She can't "keep her doctors" because she can't keep her plan because her insurance company wants to drop her and she has no protections against that. They are not renewing her policy because they are cancelling all their policies. If she, or you, have a complaint about this take it up with her health insurance company.

I detest this continued use of pure obfuscation to accuse the President of "lying" because he tried to explain that the ACA was not going to forcibly move all americans into a single NHS style health care system. The context of the utterance and the absolute barrage of misinformation that the President and the ACA have faced matter in talkinga bout what the President said, or didn't say.

But the fact of the matter remains--the ACA had nothing to do with the purely capitalist decision of her health insurer. They say so right in the linked article about how they don't want to insure people like her anymore, people who use too much costly medical care. And because the ACA doesn't, in fact, force them to maintain her policy if they terminate all such policies they can do that. Too bad. So sad. The time to fight for universal health care for all, not just for rich women, is long past. WE had our chance but Lieberman and the Republicans denied it to us and we were forced to rely on a patchwork of insurance companies.

Its a little late to act like a shocked virgin that insurance companies see their customers as profit centers, as much as if they were cows who get slaughtered when the cost gets higher than the value of the milk.

Nothing has changed for this woman because of the ACA except that she can, for the first time in history, get re-insured on the exchanges. Previously her company could have dropped her and she would have been uninsurable. Instead of bitching and moaning about the ACA she (and you) should be thanking President Obama on her knees for giving her the chance to buy into health insurance. Oh: and her little girls too.

It also goes surprisingly unremarked that because she and her husband preferred to essentially go naked instead of paying the high, pre ACA, cost of actual health care coverage that she neglected a basic physical and wound up being diagnosed so late. There are literally millions of people in this country who have died, or will die, because they didn't begin to have the disposable income of these people and could never get seen by a private physician or given the bloodwork and tests they needed.

Joseph Nobles said...

Good Lord. James Taranto at WSJ was bad enough saying that the White House attacked Mrs. Sundby for the op/ed (they did no such thing), but in his next story, he had the gall to say this: "the Affordable Care Act (that's the euphemism for Obamacare)."

Wrong day to stop sniffing glue.

Glennis said...

It always amuses me how tools like Trizzler suddenly like to use the word "lying," as if he/she staked the farm on a campaign promise and now - shockingly - finds him/herself betrayed.

A campaign promise is aspirational - even small schoolchildren can understand that. A campaign promise made in 2008 before the sausage-making of legislation has occured, before the lobbyists have staked their claims, before the obstructionists have whittled off their piece, before the oppportunists have exploited the loopholes.

Politicians on the campaign tell you what they intend CONCEPTUALLY; and realistic voters understand that if you're lucky you get 50% or 60% on the first go round.

Were you blind? out of the country? Did you somehow miss how the ACA got made? It was your guys, the conservatives and the insurance industry lobbyists, who contributed to the flaws in the ACA.

so now you're feeling betrayed because Daddy Obama didn't bring you the right toy for Christmas?

I can't believe the right wing talking points has decided to emulate the left wing emo-Firebaggers in the "why didn't he deliver 100% of what he promised" department. Or at least, I can't believe anyone would take them seriously.

Examinator said...

Aimai has nailed the case of the unfortunate people well.

I addressed the issue of the WSJ bias proclivity to run sensation and sing the praises of their more lucrative profit centers, advertisers. Because they, like most News media see their readers, watchers (attention) as cattle to be sold.

The sad thing is that there are alternatives/variations on a theme the NHS system. It doesn't have to be one or the other (Period).
The Aussie system is a hybrid system.

One that uses both the carrot and stick i.e. gives taxpayers a rebate on their private health insurance premiums.... it taxes those who don't have private insurance (PHI) an extra 2-3% after their 30th Birthday. But offers a safety net of Universal coverage at hospitals etc for the poorer or pensioned citizens.

There is a prescribe rebate for each individual service provided, to all medical practitioners for accepting the Health benefits card.

Most GP clinics accept the card or has doctors in them that do.
Despite the *heavy Hand of socialism(sic)* there are hard working doctors and some that don't what there isn't is poverty or lack of profits in Medicine.

They also have a PBS that subsidises most medications particularly those on the Health Benefits Card. There is a MAXIMUM that Health Benefits card can be CHARGED in a year once exceeded the medication is paid by the system (free to the pensioner or poor person. There is also a maximum an average citizen can be charged in a year once reached they get their meds discounted to $5.90 per med.
No one needs to go backrupt for medical bills or go hungry.
Again Big Pharma are busting their butts to have their products be PBS listed.

The only losers I can see is the advertisers ...There is no ads to end users.
One assumes that the savings on advertising makes the central PBS negotiated price worth the effort ...profitable.
I'd also add that my neighbor has had to be flown back from other states by a specially medically chartered plane first from a stroke then at another time from encephalitis all accompanied by medical staff.... at no cost to them

I put all this in to illustrate to fellow American born that the problem in America is that all discussions are extreme V extreme.

Steve M. said...

And if it's "snooping around at their granite counter-tops" to quote something else this woman wrote and published herself (the NYT blog post in which she talks about the R&R in Fiji and Alaska), then I plead guilty. And the AARP profile certainly looks as if it was written with her cooperation.

The Sundbys are in the press a lot. Courting the press may be a habit you develop when you're an entrepreneur in search of venture capital. But the point is that they're not particularly private people, Edie in particular. They've chosen to put their lives out there for a long time now, including details relevant to this discussion. I'm just quoting what they've freely and publicly revealed.

Unknown said...

Sorry there is no contradiction. A high deductible catastrophic plan (with HSA) can also be a PPO. I have one (also being cancelled) which helped my wife fight cancer. What is the contradcition?

Reticulator said...

Nobody has given a good reason for government policy to have put her and her insurance company into this situation, other than to satisfy the hate and bloodlust of the ObamaCare left. Back when there were liberals, we might have been able to compromise on a plan that maximized choice and aid. But the left cannot tolerate the existence of any human choices which might compete favorably against those they impose on us.

Their policy is the greatest evil for the greatest number. If a few people end up with better health care than before, that's a price they're willing to pay for a greater destruction.

Now there are some people who will accuse me of looking at the left through rose-colored glasses, but I hope I can be forgiven for trying to keep my rhetoric more restrained and civil than their wild accusations against insurance companies and those who don't think like they do.

trizzlor said...


They are not renewing her policy because they are cancelling all their policies.

And their stated reason for pulling out of the market was because of uncertainty over the new enrollment they would be required to take on as a result of the ACA. Yes, the agency made a capitalist decision, but that decision was driven by changes in the law. It's silly to pretend like there's a big difference "I'm going to make companies do this" and "I'm going to pass a law that makes extremely unprofitable for companies not to do this".

I detest this continued use of pure obfuscation to accuse the President of "lying" because he tried to explain that the ACA was not going to forcibly move all americans into a single NHS style health care system.

I would have been extremely happy if that's what Obama had tried to explain. I think it's important for Americans to understand that a lot of the pre-ACA plans are substandard and essentially pass the cost onto everyone else through ER visits and medical bankruptcy. But that's not what Obama tried to do, he outright said that ACA was not going to result in changes to your plan or your doctor. There's no way those statements can be unspun; especially since a big chunk of the ACA is specifically intended to reform plans. Yes, this was meant to counter the death-panels nonsense, and to anyone paying close attention it was obvious hyperbole, but wingnut misinformation is not an excuse to react in kind. Frankly, liberals should be calling out Obama on this as much as the WSJ. The ACA will (hopefully) be with us for a long time, and massaging the truth to get short-term victories is going to result in long-term losses when the truth finally comes out. So-called "rate shock" is something that Obama should have been preparing the country for so articles like Sundby's wouldn't raise an eyebrow.

trizzlor said...

@Reticulator: Nobody has given a good reason for government policy to have put her and her insurance company into this situation, other than to satisfy the hate and bloodlust of the ObamaCare left.

The reason is that the ACA establishes guaranteed issue and a mandatory minimum for coverage, as well as a host of cost-cutting reforms. Nearly everyone who studies insurance agrees that these are good things, even Paul Ryan had them in his proposal (see the Coburn/Ryan "Patient's Choice Act"). As a side-effect, these regulations will mean that some of the individual plans that were able to skim off low-risk customers will either have to take on high-risk customers as well or start shutting down their plans. Such plans are a small fraction of the health-care market, and the people for whom reform will be a net-negative are even fewer, but they do exist. Fortunately, even this fraction of people is much smaller under the ACA then it would have been under Republican proposals, which would have swept large swathes of (generally poor) people off their current coverage.

Chris said...

As far as I can tell, Blue of California offers a Platinum PPO for about $11,770/year for a 61 year old woman. It has a $0 deductible, 10% copay in-network with $4k out of pocket max, and a 50% copay out-network with a $7k out of pocket max.

So if she signs up for this Blue California plan instead, she can go to whatever doctor in or out of network she wants and her annual maximum should be $11,770 + $4,000 + $7,000 = $22,770.

Now, if she wants to make her story honest, she needs to disclose what her costs were before. She told the AARP she had a high deductible 80/20 plan that caused her to spend "tens of thousands". I'm guessing most years, when you included premiums, she was at $15,000 minimum.

So then the story becomes, wealthy woman who can afford it now might have to pay a little more of her fortune to keep getting her way. But my estimate of what she paid before is just a guess - it could have been a lot closer to $22,700 or even more. It's possible the ACA will save her money!

The real story here is that in America, the media cares more about a rich person's inconvenience who can afford to drop $100k over a 5 year period to fight cancer than they do over the many, many, many people who got cancer and had no such luxury - and might not have even had access to a "subpar" in-network provider at all.

yopd1 said...

A PPO after 2009 means she was able to switch to a PPO because there are now no lifetime maximum's for her policy and she could switch to it because they couldn't take her cancer as a pre-existing condition.

bradmaddox said...
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