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How Medicare is failing. A case study.


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2009 Dec 6, 10:16am   8,504 views  69 comments

by PeopleUnited   ➕follow (2)   💰tip   ignore  

I'd like to share with you the story of a lady who lives in a small rural community. These are actual events of the past week. She recently turned 65 and became "eligible for benefits" under Medicare. This meant enrolling in Medicare part D for prescription coverage as well as Medicare A and B for hospital and medical expenses. It came time for her to get refills on her maintenance medications so she called her pharmacy. Under her new "coverage" she was told she would have to pay out of pocket for her prescriptions or go elsewhere because the independent pharmacy she has used for the past 15 years does not do Medicare D plans.

So she had her prescriptions transferred to a pharmacy in another town farther away, that does do Medicare D plans. This, only to have three of the medications denied by the Medicare plan, requiring a "prior authorization" by the physician (in case you are unfamiliar with the concept, basically the doctor has to do extra paperwork to justify the prescription for the medication he has already written for). Upon notice that the doctor will need to do a prior authorization, the doctors office notifies the patient that she will need to see the doctor before they can proceed. So she schedules and comes in for an appointment but before she even gets to see the doctor, she shows the receptionist her new "insurance" card. The receptionist tells her that Medicare is not accepted at this clinic. She will need to find a new doctor and is given some information on a clinic 25 miles away. After 15 years she is without a doctor, has a new pharmacy in a new town, but is still unable to get 3 of her maintenance medications without paying out of pocket for the full amount.

Some believe that we need to expand Medicare and use it as a model for everyone else. I'm sure this lady would disagree.

The providers have spoken, and they are saying they would rather lose patients than deal with Medicare. The regulations are onerous and the compensation for services is not fair. More and more providers are either closing shop or refusing to contract with Medicare. This results in loss of choice for Medicare patients and everyone else. Add to that the 75+ billion dollars lost to fraud, waste and abuse each year and you have a pretty good idea of what Medicare is doing for us and to us.

It is time to get government out of the health care business. This lady was better off without their "help", and you are too.

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65   tatupu70   2009 Dec 8, 8:20pm  

AdHominem says

I am all for VOLUNTARY wealth redistribution. Where I have a problem is when people are FORCED to do so

So, you're against car insurance then too?

66   PeopleUnited   2009 Dec 8, 10:27pm  

tatupu70 says

AdHominem says

I am all for VOLUNTARY wealth redistribution. Where I have a problem is when people are FORCED to do so

So, you’re against car insurance then too?

Sure. Warren Buffet and Gieco don't need mandatory customers.

67   elliemae   2009 Dec 8, 10:36pm  

Leigh:
Just remember that some hospice nurse doesn't have the right to tell anyone what to do with the meds. They catch you in an emotional moment and demand that you waste the meds.

I've also seen hospice nurses take the meds, sell them or use them for themselves. It's their word against anyone else's.

68   Leigh   2009 Dec 8, 11:14pm  

AdHominem, can you address this previous comment. It's a crucial part of the debate3. What would folks 65 and old do for insurance w/out Medicare? What would the housewife who has never worked out of the home and now is widowed do for health care? WHat are your solutions?

"OK, say we throw Medicare out the door. Take all the money she had been contributing these past 40 years and put it toward private insurance after retirement. How much money do you think that would be? Would it be adequate to afford the premiums in the ‘free market’, imagine all of her pre-existing conditions. Would she have enough funds for 20 years of premiums, co-pays and deductibles, medications? And consider the premiums would be based on age and health.

In my mind, the 65 and older folks drain the health care dollars. Not only would their premiums be sky high but there will be much more scrutiny of where the dollars are going. Yes, private insurance has ‘death panels’ just ask any transplant doctor."

Do you realize how much health care is consumed by this age group? You really think charity can absorb half of it. You will see death panels if charity is what the majority of this age group is left with. DO you realize how much an MI can cost you especially if it involves bypass surgery, an ICU stay and meds, assuming you lived? Would the debt get passed on to your loved ones?

69   Leigh   2009 Dec 9, 3:09am  

And should all of our veterans rely on charity?

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