The Rant Continues

[gja1000]

We've had Medicare since 2005 - or I should say Gary has had Medicare since 2005. It has been fine, we've not had any problems at all with it. However, you MUST have a secondary policy that covers what Medicare doesn't because Medicare only pays 80% of most things. Gary had open heart surgery and we would have been out thousands of dollars if we'd had to pay 20% of the bill. Also you need a secondary insurance for the RX benefits. Medicare's plan D for prescriptions does not cover everything (but the new health care bill does increase the RX benefits so that is good). At least it is better than nothing though. Prior to Medicare part D, there were no prescription benefits with Medicare and as you all well know, prescriptions can cost hundreds of dollars per month if you don't have insurance.

Medicare part A is the physician coverage and Medicare part B is the hospital care. You have to pay a premium for Part B, but it is worth it. Judy, you will get that book every year. I just throw them in a drawer.

[judy]

Thanks, Gayle! I have GHI as my secondary insurance, and have part D already. I have to pay for it, from my SS check, but it seems that the teachers' union reimburses us every year for the cost. I think I will get 75% for generic prescriptions. I don't know what percentage I pay now, so I will see. I only take one name brand - Nexium. If there is a generic, I'll switch.

I am very, very fortunate to have this coverage. The teachers' union is wonderful to us. We are covered for life! I loved teaching, but having taken care of all those people's children for so many years, I think it is fair that their taxes take care of me now! All of these anti-unionists can go screw themselves as far as I am concerned! I would like to see any one of them teach a class of 30 teenagers, and do it well.

[gja1000]

I had lunch with a Nurse Practitioner friend of mine this past week. She has her own practice with a doctor in a little town near the lake where Gary is fishing. I was telling her my woeful story of trying to get Gary's neck injection scheduled, his medications ordered, and getting his insulin pump supplies increased to match his needs. She just shook her head and said that I was motivated and knew what I was doing and I persisted until I got what was needed. However, she went on to say that most of her patients can't or won't do that and they just give up. When they come in to see her days/weeks later, they have not scheduled their procedure or they are not taking their meds (even the essential ones) because they couldn't get what they needed so they just gave up. It is so scary to me that this happens, but i know it does. I remember being told that Gary's doctor wouldn't approve something and I knew that was not true - but most people would have just believed that, and thought OK, I guess I don't need that medication or whatever. It's just too sad.

[DianaB]

I'm not to that stage of life yet and it scares me to think that getting health care will be so difficult that I'll give up. I hope that Gary appreciates the fact that he's in good hands!!

[Janet]

Wow...I feel the same as Diana. It's getting scarier and scarier to grow old. Sure wish you and Gary didn't have to deal with this.

[judy]

My doctor told me that a lot of doctors up here are not accepting Medicare because they pay so slowly! We do have good clinics here though, but for a doctor not to accept at least a percentage of indigent patients is just wrong!!
They do make an awful lot of $!

The drug companies and the insurance companies need to be regulated. I do not like the idea of government control over everything, but at some point, greed outweighs rights of commerce!!

It is a slippery slope, but too many people are without health care and medicine.

My dental insurance company is a good example...I just went down to the city this week for him to fill in another form!

[DIANE W]

Goodness it must be so worrying for everyone, i understand the health provision is very different in the States to ours in England, when i hear your stories, i thank my lucky stars that we dont have that worry, we have unlimited access to free health care (well we do pay through our National Insurance and Taxes), but it is free at point of access.

Your right it is good that a person has someone looking out for them, i remember when i was at the hospital with my Aunt, some patients didnt have any visitors at all, and i was so concerned about decisions that were made, about their care, with out someone looking out for them.

Even now i am the only carer for my Uncle..... and i have to double check his medication, sometimes the pharmacists make mistakes, and what worries me is if the older person lives alone and doesnt realise it is a mistake

[DianaB]

Your pharmacist makes mistakes???? My daughter used to work in a pharmacy and that is a HUGE no-no. You need to change who you go to. That can be deadly.

[judy]

Brandon was in a very good hospital, but it is in Albany, a large city. They are all understaffed. She had to be there 24/7. If she had not insisted and fought for CAT scan, they would not have found what was wrong with him. The physician on the floor also sent him home without one medication, and an undated prescription for pain meds, which could not be filled legally. Luckily, the surgeon is a wonderful doctor who called to see how he was and is going to straighten everything out.

Brandon's roommate was an 8 week old baby who was so abused by her father. It was on the news, and is in all of the newspapers. Jessie wanted to take her home! The doctors were discussing giving her morphine because she was crying.
She does have a lot of damage, but one nurse carried her whenever she could get time, and she stopped crying. Babies need to be held,not given morphine!

How is your national health plan, Diana? I find the Obamacare plan very confusing, and I really do not know what is offered by it. A lot of people here are very much against it. Do gov't health plans work out well?

[gja1000]

Judy, I can tell you about the Affordable Care Act, aka Obamacare. It really is insurance reform and it is nothing like national health insurance as Diane describes. The Affordable Care Act is a start, but more needs to be done. It has some really good aspects, in my opinion. When fully enacted, insurance companies will no longer be able to deny coverage for pre-existing conditions and there will be no lifetime cap on the amount of insurance benefits (often $500,000 or $1,000,000 a which sounds like a lot but really isn't when you have lots of problems like Gary). These two things alone are a godsend for many people. it also mandates that insurance companies have to pay for health promotion because a part of the Act is to try to save money by getting people tne care they need before they get chronically ill and by providing health promotion. It also requires insurance companies to allow parents to keep unmarried children on their policies till 25 or 26 (I forget which). This is really great because so many college students are uninsured. It increases the amount that Medicare Part D pays for prescription meds and reduces the out of pocket expenses.

The controversial part is that everyone will have to buy health insurance - but heck, everyone has to buy auto insurance so why not health insurance. This will partially be accomplished by increasing the Medicaid eligible numbers. Right now, you have to be very very poor to get on Medicaid, it's currently like 200% of poverty and that will change to 144% of poverty, so tha people with low incomes will not have to buy insurance, they will be eligible for Medicaid. Many people don't like this, but I think it's OK (thats because i see what happens when people cant get health care till they are severely ill). People with incomes near the poverty do not have money to buy insurance. This is part of the Act that is being challenged by several states. The Supreme court will hear these two challenges (the individual mandate and increasing the numbers eligible for Medicaid) week after next, March 25 & 26, I think.

Others who don't have insurance through their employers will be able to buy low cost insurance though insurance exchanges (states can band together or go it alone to create an insurance exchange so that the rates are affordable). This is much the same as those who have to pay some or all of their insurance premiums through their employer. It really isn't any different than that. There are other aspects in the Act, but basically these are the aspects that affect the populace.

A really good source of information is the Kaiser Family Foundation. If you google Kaiser & Affordable Care Act, you will get lots of links that summarize the provisions in the act in plain speak. I have a couple of sets of slides that I can post that also summarize the act pretty well.

[DIANE W]

Originally Posted by DianaB

Your pharmacist makes mistakes???? My daughter used to work in a pharmacy and that is a HUGE no-no. You need to change who you go to. That can be deadly.

Actually Diana, we have changed, we moved from the one attached to his Dr's, to one 7 miles away, they still deliver his medication every month, i watch carefully, I make sure he gets all he needs. They annoy me though as he has regular medication, and yet still they leave things off, which means i then have to chase around.
I just feel sorry for older people who perhaps havent got anyone to look out for them, and do these things, it must be hard on them.

[DIANE W]

Originally Posted by judy

Brandon was in a very good hospital, but it is in Albany, a large city. They are all understaffed. She had to be there 24/7. If she had not insisted and fought for CAT scan, they would not have found what was wrong with him. The physician on the floor also sent him home without one medication, and an undated prescription for pain meds, which could not be filled legally. Luckily, the surgeon is a wonderful doctor who called to see how he was and is going to straighten everything out.

Brandon's roommate was an 8 week old baby who was so abused by her father. It was on the news, and is in all of the newspapers. Jessie wanted to take her home! The doctors were discussing giving her morphine because she was crying.
She does have a lot of damage, but one nurse carried her whenever she could get time, and she stopped crying. Babies need to be held,not given morphine!

How is your national health plan, Diana? I find the Obamacare plan very confusing, and I really do not know what is offered by it. A lot of people here are very much against it. Do gov't health plans work out well?

Judy..... I have never known any difference than what we have now, our national health service, covers everything at the point of need. We get free access to Dr's and hospitals, 24 hours a day, i am very proud of our health providers, they do tremendous work, under difficult circumstances sometimes. We pay for our prescriptions = 1 item is currently £7.40, unless you are on low income, or have certain medical exemption, like being diabetic for example.
We pay national health contributions through our salary, it is a percentage, not sure how it is worked out.

[JJJ]

I would love to have your medical system Diane W. I don't think the Obama is a bad plan. Those who are against them are those who own their own company. I also think they need to work on it a bit more to keep every side happy.

I have been without insurance for years now. If I get insurance from my employer that's half my pay. My boys qualify for CHIP and I pay a monthly premium so I'm happy with that. But once my boy had to had stitches and that cost me $2000 out of pocket and he didn't even get a room in the hospital. They clean him up and staple him with no anesthesia or numb med.

[judy]

That's terrible Jessica! Will you have better medical care under the Obama plan?

Thanks for the explanation Gayle! I have insurance, plus Medicare now, so I am very lucky!!!! I did start using the Part D of Medicare, and the one prescriptiom was only $1.50 co-pay instead of $5.00. CVS used to charge me $17.00 for my co-pay. I changed to our local pharmacy, which is much cheaper.

I get most of my prescriptions by mail. I don't know what the co-pay will cost this month since I began Medicare. It usually costs me about $10/3 month supply. I cannot complain!!! The only thing that is more is Nexium for $40/3 months. I tried the otc and I think the Nexium works better for me.

I would not mind contributing some so that everybody has affordable health insurance. I am of the "it takes a village to raise a child"m philosophy, and feel that we all have to take care of each other.

[JJJ]

I have not read too much on the Obama plan but hopefully it's something better than what I have. They were going to implement a law that anyone who benefits from the government should be drug tested. I was all for it but I really don't know what happen or was it just hear say.