Sunday, August 16, 2009

Health Care Systems in USA

I know it is hard to understand the thoughts of the Americans. I have for years thought that the Medicare System would work well for the aging, and that the Medicaid( state run health systems) Would be good for the Needy. Well I have experienced both in my family and they do not work. I believe this is why there is such a wide spread difference in the peoples thinking. If you have no experience of the.. now in place.. HCS in America then your view is clouded. Trusting the Politicians words is another issue in it's self. We read the policy and listen to the politicians and the two do not match..So, what will the bill finally turn out to say? One does not know.

This was my response to The Way I See it " The Health Care Debate" Post. I have read many views on the subject but I have to say His was a breathe of fresh air. We can get pretty heated with our opinions on this matter. One can write some cruel words in comments and on blogs. That is one thing I do not want to do. The thing for sure is we do need a better, affordable Health care Insurance. My Motto has always been " Nothing is free" there is always an expense. The question will be How Much?

When my Mother was diagnosed with Ovarian Cancer I learned a lot about the Now Medicare system. When she decided to go to the Cancer Treatment Center of America in another state. I learn a lot more about Insurance companies as well as Medicare and our Governments control.
I was thrown into a world of not being able to get the care we needed. So I thought I would share my experience.
Mom was diagnosed in 2005, we were sent to a oncologist who informed us the Medicare will only cover one type of treatment but there were other organizations that would help and their pamphlet were in the waiting room. As for the Drugs needed to counter act the side effects.. Those are not covered even with the New Medicare D program. I could not understand this. I Knew they had insurance with USAA, so I ask will they cover it. Mom said no, They will only cover what medicare covers. It was only to help with the 20-50% and co-pay they would have to pay. Boy was I shocked, I thought Medicare was to pay for all of health issues. Then I started to ask questions; Could you have gotten another insurance company to cover what medicare didn't? Answer.. No, once you start receiving Social Security one is locked into medicare. What is covered? Here is a specks of what is covered:
Medicare Part A only provide Hospital care. You pay $1024 deductible for first 60 days, $256 daily deductible for days 61-90, $512 daily deductible for lifetime reserve days. You have a total of 60 lifetime reserve days over the course of your lifetime and if you need a Skilled nursing facility care, for a limited period following a minimum 3-day hospital stay for a related condition or injury. You must require skilled care to be eligible for coverage. You pay $0 for the first 20 days, $128 daily for days 21-100, and all costs for each day after day 100.
look at the rest;
Blood, starting with the 4th pint you receive from a hospital or skilled nursing facility during a Medicare-covered stay. You pay all costs for the first three pints and 20% for each additional pint.
Necessary home health services. May include physical therapy, speech therapy, some durable medical equipment (such as wheelchairs, oxygen tanks, etc.) and medical supplies for your home. You must receive services from a Medicare-certified home health agency. You pay a $0 copayment for home health services and 20% coinsurance for durable medical equipment.

Part B- cost $135 yearly and is taken out of your Social Security check in monthly installments. This covers, Dr. appointments, only first one free. Outpatient and preventive services and it covers your Flu shot which is the only free item. They only pay 50-80% of the bill so one has to pay the balance and what ever is not covered. Really this is the same as most insurance companies. One can take out a supplemental medicare insurance from an independent company. They will cover the 20-50% and Co-pay but because of the laws in place can not cover what is not authorized by Medicare. I just could not believe, I would not be allowed to collect S.S. and choose my own Medical insurance. And Lord knows I did not want the Governments! My decision was not to start receiving S.S. when I come of age. Keep my money and leave me alone!
Mom made it though the first treatments and manage to not spend all their hard earned savings, thanks to some organizations.
When the Cancer Raised it Ugly Head again in 2007. Mom went back to the Same oncologist who stated that she could only use one other drug. It was the most powerful there was. Mom started treatment. Early on she decided to check out the Cancer Centers of America and get a second opinion. We met with a Doctor Willis, renown for his treatment of Ovarian cancer and was instrumental in developing the drug mom was being given. His words were, You do not want to be on that drug, There are better ones for your cancer. We told him medicare will not pay for them. He said, You let the billing department take care of that, we want to work at making you healthy. So we did! During the treatments my Mom needed to be feed through her veins, medicare would not cover that unless she was in the hospital and only if she had other test/ surgeries to prove she needed it. We had to pay out of pocket for the feedings at home and the center paid for all the feeding at their facilities. They would not pay for nurses to come to do the feeding, so Thank God for my Nursing degree I was trained and administered them myself. She needed oxygen , medicare would not pay for it unless she had a lung disorder. She was able to get it due to the great work of the cancer center staff and we are not sure if medicare ever paid. she had a chest tube inserted and medicare would only pay for Home care 3 days a week, it had to be change daily so, yes I did that too. The sterile dressing and draining. I will tell you we fought Medicare all the way. I guess they felt a 70 year old women was not worth the cost to keep her alive through the treatments. I will tell you Ovarian cancer is very treatable with today's medicines, they have come a long way. Mom Died in January 2008 from the complication of the side effects. Which had treatments to help with them..also not covered. We spent a lot of Money on drugs to help. The Center spent a lot money through grants and some times just said we will take care of it. I had to call bill collectors to get them to forgive the bill,(Write it off )after Moms death. I was very dishearten with the medicare system. There was just no reasoning with them.

I later learned that even if I wanted to have my own insurance at retirement age, I could not. Even if I decided to work at retirement age medicare will kick in and I will not be able to keep my current plan. Boy this really sucks. That is why I feel very differently about a Government Run Health plan.
Some Reform needs to be done to allow people to choose what plan they want and free the Independent companies to cover the Retirement age folks if they want a different coverage.

I hope this help you to understand the thought patterns of the Americans. We all want to have the right to health coverage and for everyone to be able to get care. I will tell you we have a lot of organizations that will help people get care. There are More Hospitals and Health Centers in America than any other country on this earth. We have hospitals who will care for a person whether they have insurance or not. People want to help the needy, so here we are today. What will happen?

Information on current Medicare plan provided by Senior Health Insurance,

1 comment:

  1. I wanted to add I know about the chest tube stuff, terrible isn't it. Mom had of them; 2 while still in ICU; though 3 all together. Medicare did pay, and the bulk of 7 wk long hospital stay, with more lab,x-rays, IV's, blood transfusions etc than I can count.

    I think my entire extented family would be flat broke had it not been for medicare. I had a bit more of trouble with MIL's bills, but I think that might have been due to computer records not being as good then as now?

    Sorry yu had such a battle, this battle is I believe another thing that is a plus. If we had Natl. Care, we would not have to battle, everyone would have coverage.