Monday, June 13, 2011

Facing the facts about health insurance... (w/ Update)

is really very simple.

Somehow, in the past 50 or so years, the entire concept of health insurance has been turned inside out and upside down.  No longer do we insure against a catastrophic event, what was once called a "major medical" policy, but now expect our insurance to pay for hangnails and head colds. 

As a nation, we run to the doctor for the most trivial of reasons because "it's free."  This phenomenon is not relegated to the people who are insured through their employer, but includes Medicare recipients also.

A number of years ago, I had a lady friend who was on Medicare.  She had problems with the maintenance of her toenails and so her doctor referred her to a podiatrist.  Every six weeks, she visited the podiatrist to have her nails clipped, not by the doctor, but by an assistant in the office.  Medicare was billed for an office visit and for the clipping of her nails, a procedure that could have been performed by any competent manicurist.  Of course, if she went to manicurist, she would have to pay $5.00 or $10.00 to have her nails clipped.  Why do that when you can get it done for "free."

Both my husband and I are recent receivers of this abomination called Medicare.  Unlike most recipients, I carefully review the statements for our services.  Just a few weeks ago, my husband had a electrocardiogram performed.  When I saw the amount billed to Medicare, I almost had a stroke.  A relatively simple procedure, the technology of which has long since paid for, cost close to $4,000.00.  A doctor isn't even required to do the procedure, a technician being sufficient for the job.  Admittedly, a doctor "reads" the results, which were already known to us by the nurse.   What Medicare actually paid the clinic for the procedure is an unknown, but not for long, since I plan on spending some quality time with the billing office to find out this information.  

Except for a period in which I worked for Costco, we self-ensured by carrying the equivalent of a "major medical" policy with a high ($2500.00 - $5000.00) deductible.  Our doctor had opted out of the whole insurance racket, which was fine with us.  If we needed to see him, an average office call amounted to $60.00.  Often, he spent at least an hour with us.  Contrast that with our new Medicare provider, which we are lucky to have as most doctors don't accept Medicare patients.  He bills Medicare an average of $200.00 - $300.00 per visit, which lasts an average of 15 minutes.  This is necessary because he is only compensated a percentage of this amount.  And around and around it goes. 

Obama, when he's not golfing, specializes in division - race against race, rich against poor, and old against young.  The majority of comments on Medicare are young people railing against us oldsters.  How dare us expect to get our health care for "free."  Might I remind them that we were not given a big say-so in this whole deal, and that we have paid into it since its inception.  Problem is, there are many of us who know the system is rigged.  My mother, who worked in the health field, knew back in the 60's that Medicare was not a good thing, and was not in favor of its passage.

All you lefty loons who think Obamacare is the solution, had better wake up and do a bit of research.  If Obamacare remains in effect, something I doubt will happen, your "health care" will consist of sitting on a waiting list to see one of the few doctors still practicing. But, cheer up - it'll be "free."

"Fixing" the system is simple.  I've said it over and over and people with all sorts of fancy degrees to back me up.
  • Get rid of employer provided insurance, something that arose as a result of wage controls.
  • Go back to the concept of "major medical" policies and pay for your own routine office visits (oh, the inhumanity.)
  • Tort reform to limit frivolous law suits so your doctor doesn't have to practice "defensive" medicine.
Ann Barnhardt, of bacon laden Koran burning fame, explains it simply it her trademark no-nonsense style - and we thank her.   


I apologize for not including Ann's link.  Bookmark her site.  She posts some exceptionally good articles.


WomanHonorThyself said...

hey Adrienne..its the gimme gimme gimme generation..ack! happy Monday my friend!:)

Motherhen said...

Since dh was laid off and got a new job, we're without health insurance until open enrollment @my work in August. I"m still not sure if we're going to get it. I'm heavily leaning towards an accident policy, but it's so difficult to find out the particulars without speaking w/an agent, which amounts to "upsales" to me.

Anyway, my oldest son had an infected ingrown toenail at the beginning of the year. I took him to the doctor and he lanced (or whatever they do), cleared out the infection and then scheduled an appointment for him to have the ingrown nail permantely removed. The 1st procedure, the doctor was amazed we were paying cash. We received a very large deduction because of it, probably about 1/2 off. The follow up would have been billed to the insurance with me having to pay our co-pay if we have had insurance, but since we paid cash for the less than 4 minutes the doctor took to look at his healing foot, the doctor waived the charge.

He did the same for the removal procedure.

If we were to do like you and your husband did and carry a major medical with a high deductible, it would amount to the same thing, paying cash for any doctor visits or small outpatient surgeries. I think this is the path we're going to go down, unless of course, Obamamacare becomes the norm.

Anonymous said...

$4000!!!!! I'm almost ashamed to tell you that i went for my check-up and electrocardigrm last week (here in Venezuela) and the total bill came to an equivelent of $30.

Old Bob said...

During November and December, I sustained four injuries, each of which necessitated a trip to the ER of North Memorial Medical Center (i.e. hospital) in Minneapolis, and stitches to the total of 21. I'm paying off the bill in bits; it will take several years.

Reaganite Independent said...

Great post Adrienne- we've got to insist on a GOP candidate who promises to repeal ObamaCare

Note: Bachmann pledged to already last night, and said "you can take it to the bank"- that's what I'm talkin bout!!!

Always On Watch said...

I could write a book about the health-insurance scam!

The system is presently designed to force us onto Medicaid -- as Mr. AOW and I discovered when he had a stroke in September 2009. It took the threat of litigation for me to be ALLOWED to take him home. Please see THIS for the details. Excerpt:

In fact, in spite of the ninety days of coverage supposedly provided by the health-insurance plan the hospital refused to keep Mr. AOW any longer than two weeks or to release him to home. Instead, the hospital and the nursing home teamed up to release him only to a skilled nursing facility, which costs a minimum of $350 per day.

At both the rehab hospital and the nursing home, both of which were in-network facilities of Mr. AOW's health-insurance plan, I was repeatedly advised to obtain Medicare and Medicaid. This mandate, in spite of the fact that Mr. AOW was not eligible for Medicare at the age of fifty-nine and has always had health insurance for, lo, three decades!

When I pointed out to the hospital and the nursing home that Mr. AOW and I had too many assets to qualify for either Medicare or Medicaid, I was advised to liquidate all those assets that Mr. AOW and I had spent a lifetime accumulating, go bankrupt once those assets were consumed by medical care, and become beneficiaries of the Nanny State. By the way, all assets were on the table, including retirement accounts (IRA's).

Looking back, I realize that both the hospital and the nursing home anticipated that Mr. AOW would always be a resident of the nursing home, never mind that he was admitted there for stroke therapy and not as a long-term resident.


Once we established that Medicaid was not an option and that I was indeed determined to bring Mr. AOW home, I was threatened: "We'll have to report you to adult protective services."

So, how did I bring Mr. AOW home without getting arrested?...

One has to prepare in advance NOT to forced into medical bankruptcy and thereby onto Medicaid, which is rapidly going belly up, too.

Always On Watch said...

People will find out the hard way that just because a health-insurance policy offers a certain benefit, that doesn't necessarily mean that you'll get that benefit. So much of what's in a health-insurance policy is dependent upon pre-authorization or some other form of approval.

One MUST have certain documents in place and in hand in advance. Trust me on this!

Always On Watch said...

Financial problems with Medicaid:

...Unlike Medicare, the health-care program for the elderly that is funded by the federal government, Medicaid is paid for jointly by the federal government and the states. The federal government sets baseline standards of health coverage and eligibility for the program. States are free only to expand, not cut back, the coverage.

Currently, the states seeking permission to tighten eligibility — New Jersey and Arizona — are among the more generous Medicaid providers in the nation. But as the cost of the program has mushroomed with the ever-increasing price of health care and a flood of new enrollees because of the recession, those costs are becoming unmanageable for fiscally struggling states, according to the GOP governors.

The federal stimulus program provided more than $100 billion to help states pay for Medicaid during the depths of the recession, but that money is all but gone.

Christie’s proposal would deny new Medicaid coverage to adults in a family of three who earn more than $5,300 a year, down from the current cutoff of $24,645. The eligibility change is part of a broader plan to save $300 million in the state’s Medicaid program.


The health-care reform law, which goes into full effect in 2014, seeks to make coverage nearly universal in large part by expanding Medicaid....

Put that information together with my above comment and the increasing numbers of Baby Boomers, and you will see a growing pattern of financial unsustainability for individuals -- not just for the health-insurance industry.

In my view, one of the purposes of the Healthcare Reform Act is to force America into nationalized medicine (socialized medicine).

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