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I love that ... and coming from a segment of the workers that are going to truly be affected immediately as this kicks in (some already are). This is part of the message that we must focus on and convey in the months ahead. The costs to our society and heritage as a nation of Exceptional-ism will be staggering. We must not settle for mediocrity !
Please post the summary of the discussion you had with a surgeon. It is very telling.
In some sense the question being asked (I wish it were asked explicitly) is what is the best way to manage our resources as a society. With Obamacare the answer is that the government is the best way to manage our resources. The government can only decide how much to spend and who receives what treatment. They clearly can't make decisions based upon the needs of individual citizens.
Individuals, on the other hand, can make decisions about their treatments. My wife and I have just gone through a mini version of that with her cataracts. We are on Medicare and they pay 100% of a generic treatment, which is a generic lens and 1 pair of glasses to last a person for life. In this treatment a surgeon removes the old diseased lenses from the eye and replaces them with a generic pair.
We learned there was a different treatment option, which was to have careful measurements of the eye made and then a custom lens crafted and surgically implanted. The benefit of this procedure is that vision is restored and glasses are not required. We looked into it but Medicare doesn't cover it and so we had to pay the entire bill ourselves. Supplemental insurance, at least with our policy, will pay for no procedures unless Medicare covers part of the cost. Thus, rather than the logical approach which would be that Medicare pays part of the cost for the enhanced procedure the patient is left to pay the entire cost if they elect for the higher quality treatment.
As individuals it would be better, it seems to me, if we all have the treatment that works best for us. We can each make our own decisions based upon our circumstances and resources. Should we allow someone to go blind if they are too poor to pay for treatment? Of course not. Should we have a system that forces everyone into a one size fits all plan to ensure a basic "fairness"? of course not.
I thus argue that things will work much better if people are allowed to solve their own problems with their own resources. Government needs to get out of the resource management business.
Unfortunately in my job I deal with Medicare and Private insuance daily. Both suck-excuse the word but it was the only one I could think of that sums it up. A small example- medicare will not pay for a bedside commode if a person also is getting a walker. So a patient who had a hip replacement has to walk to the bathroom in the middle of the night instead of just pivoting onto commode at the side of bed. Usually they have a leg immobilizer and have to put it on (about 10 velcro straps) each time they walk. This absolutely makes no sense. That is medicare. As for private insurance example- a patient is taking the medication Celebrex, there is no generic and has tried other similar medications but Celebrex works the best. The doctor who orders it has to write a letter to send to insurance and hopefully some of cost will be covered, Celebrex is about 90.00 for a one month supply. I am a homehealth RN. I go to see a patient who needs extensive wound care daily. I get approval for one visit- then I have to submit a request to the insurance company and wait for approval for more visits. I have waited over 5 days to get approval, so the patient who can barely make it into the next room has to either try to do themselves (when their 80 years old kinda difficult) or find a way to go to the dr's office every day to have them change it (which is difficult if they don't drive and take votran bus service) this is just a couple of small examples and only the homehealth field. I hear stories from both medicare and private and to tell the truth no option is good. the private insurance companies will deny diagnostic tests- the person who denies is not a dr and you would think that since a dr ordered it there is a good reason but no. Medicare will pay for a person to be in rehab after surgery for 20 days, that is good except what if patient needs more? A 70 year old with multiple co-morbid diseases who had a leg amputations needs more than a 57 year old knee replacement patient. I am venting, I just get so frustrated that some paper pusher is deciding the "proper" care of a person they know on paper only. Most doctors do not order tests/labs/medication unless they deem it necessary for the patients health. Something needs to be done, the only thing I know is regardless of medicare or private their bottom line will not be affected, unlike the patients health. Sorry for the long post.
Long post is appreciated. In November last year I turned 65 and decided to accept Medicare. Long story there, but it has been a pain in the neck since. For those who don't know, it is a means tested program and because of my earnings I pay a good deal of money to be on this "free" program that ... as Sharona says ... sucks.
My wife needs cataract surgery and Medicare has exactly one option. Generic surgery and eye glasses. As we learned there is an option to have, in essence, contact lenses made that are then implanted in the eye. This eliminates the need for glasses. However, Medicare doesn't cover this treatment and so they pay NOTHING. Not the difference in price between what we want and their standard compensation; nope they pay nothing. The supplemental insurances take their cue from Medicare. If it pays nothing then they pay nothing.
So, here I am having payed into this program all of my life; here I am paying almost as much in premiums for Medicare as I was when I paid for my own policy; here I am paying my own money to provide the best health care possible for my family. I did spend 3 days solid on the phone with the surgeon's office and with my supplemental insurance provider, after which I managed to reduce the bill from $4,000 to $1,600. The eye surgeon found out we were going to pay cash and he reduced his bill because of the paperwork savings. When he helped out the supplemental insurance provider decided they would save a pair of glasses and so gave us some help too. Medicare stuck to the bureaucratic policy -- take what we give you or you get nothing.
Medicare is an awful program that people have been conditioned to believe is a great benefit.
I would rather the government send me a check and let me shop for my own plans. I'm confident that I would come up with something better than I have now. I'm rooting for Paul Ryan all the way on his new budget proposal. If we can give the responsibility for the health care system back to patients and back to doctors it will work better.
Well worth the read if you have not ...