One of the common responses on the part of the health care reformers to the townhall meetings last August was to repeat the story about the man/woman who ignorantly says, "Whatever you do, keep your hands off my Medicare!" Ha! Ha! Just shows you how ignorant these critics are: they don't even understand that Medicare is a government program! There's obviously no reason for us to pay attention to the majority of Americans who oppose health care reform. Medicare is the most successful government program ever enacted. Duh!
Well, here's a question for you. How satisfied are patients with Medicare ... without a Medigap policy? Medigap is a supplemental plan offered by private insurers to cover the incredibly gaping holes in Medicare coverage. I am new to Medicare, because of disability, and I do not like it!
The biggest problem with Medicare is that I do not have my choice of doctors, despite the statements of our so-called health care reformers. They say I will continue to have my choice of doctors under the reformed system. But, Medicare patients do not have their choice of doctors now. The publication "Medicare and You" says they do but then qualifies the statement. Question: "Can I get my health care from any doctor or hospital?" Answer: "Yes. You can go to any doctor, supplier, hospital, or other facility that is enrolled in Medicare and is accepting new Medicare patients." The truth is that Medicare reimbursement is so bad that fewer and fewer doctors are taking new Medicare patients. They cannot afford it. They need a high volume of patients with private insurance to make up for the losses they incur from Medicare patients.
The neurologist reputed to be the best in our area simply will not take Medicare patients. Who can blame him? The neurologist who performed my most recent EMG was only reimbursed $36 for her time. She spent more than an hour on me. It was by far the most careful, thorough, and precise of the five EMGs I've had. She earned all $336 she billed. Why should she accept close to 10% of the amount billed?
Even the Mayo Clinic is experimenting with turning down Medicare patients. They announced this week that their clinic in Glendale, AZ, will no longer take Medicare patients. This is a pilot to test whether they could do the same in other areas, too.
No, Medicare patients do not have their choice of doctors.
Besides, Medicare coverage is not all that great to begin with. Part A has a $1068 deductible for a hospital stay. That is, unless the patient has a supplemental plan through a private insurer, they will pay over $1,000 out-of-pocket. In addition, many of the services received during during a hospital stay are not covered. Who knows what my bill would have been had I been on Medicare when my appendix burst? The Medicare publications themselves recommend buying a supplemental plan to avoid that kind of potential disaster. (By the way, Medicare has a lifetime max, too, just as private insurers do. What will the reformers do about that? Are they lifting the lifetime max on private insurance only or on Medicare as well?)
Maybe these ignoramuses at the townhall meetings weren't so ignorant after all. Maybe they knew what apparently our legislators don't: that Medicare relies heavily on private insurance to succeed. Privately insured patients subsidize Medicare patients; without them physicians would lose too much money to continue practicing. Medigap plans offered by private insurers plug the gaping holes in Medicare coverage. Private insurance makes Medicare work ... when it does.
Sunday, January 10, 2010
Tuesday, January 5, 2010
Death Panels
This is a short response to those who automatically assume that the use of the phrase "death panels" is ignorant and stupid; that it can't possibly have anything to do with health care reform simply because the bill doesn't use that phrase. Of course, much of this knee-jerk reaction stems from an animosity to Sarah Palin, the one who used the phrase in the current health care non-debate. However, even the "Wall Street Journal" wrote recently as though doctors and nurses would not recognize that expression.
I have no idea what Sarah Palin believes or knows about health care; however, those who instantly dismiss her with ridicule only show their own ignorance and unwillingness to do a little investigations.
"Death panels" are too well-known among older physicians and nurses and those of us who have worked extensively in the health care system. When dialysis machines were conceived and first put to use (and believe me they were incredibly primitive) they were used for patients who had suffered acute renal failure. That is, their kidneys had quit working, but temporarily, probably as a result of another condition. The dialysis machines were not used for chronic--that is, permanent--renal failure. In addition, hospitals only had 1 or 2 machines. Therefore doctors' panels would convene to decide who would get dialysis treatment and who would not. Without the treatment, unless the patient's kidneys spontaneously restarted, the panel was consigning patients to death. Doctors and nurses referred to these panels as "death panels."
Now the interesting thing is that Teddy Kennedy successfully got Medicare Part B to cover ESRD (End Stage Renal Disease) patients, making the kidney the only entitled organ in the body. (People on Medicare probably skip the portions on ESRD in their "Medicare and You" books, but it is there.) At the time ESRD coverage passed, dialysis was still just used for acute patients, and was cheap. The fact that there was a governmental program reimbursing health care entities for dialysis created a new industry. For-profit centers were formed with many more machines, which at the same time were constantly improving. These for-profit centers were able to start providing treatment not only to patient with acute renal failure, but now also those with chronic renal failure. Today, there are ESRD chains, the largest in the world has 1,700 clinics in the U.S. alone. ESRD coverage has come to represent 8-10% of the Medicare budget even though the patient population is tiny. Each patient uses $60,00-$70,000 in dialysis services per year.
The profit motive, though catalyzed by Medicare, solved the problem of "death panels" in our hospitals. Of course, the concept of death panels is not limited to end stage renal disease patients. Many doctors have been required to participate on panels that decide whether treatments ought to be used for patients. However, the phrase "death panel" was used explicitly and commonly with regard to ESRD. Is it stupid, therefore, given the role of the profit motive in extending dialysis treatments to the chronically ill, to ask what will happen when the profit motive is mitigated?
Why should journalists automatically assume that Sarah Palin is too stupid to know anything about health care. As the governor of Alaska would she not have been responsible for the state's Medicaid program? Does Medicaid work differently in Alaska than in the rest of the states? Which of the 9 Medicare regions does Alaska belong to? Could she perhaps be familiar with Medicare programs? Given that she has a child with Downs Syndrome, isn't it possible that she's spent enough time in hospitals to have learned some of the hospital lingo? Even if Sarah Palin knows nothing of the history of "death panels" those who laugh at her for using the term, especially journalists, are showing their own ignorance of a true health care problem.
I have no idea what Sarah Palin believes or knows about health care; however, those who instantly dismiss her with ridicule only show their own ignorance and unwillingness to do a little investigations.
"Death panels" are too well-known among older physicians and nurses and those of us who have worked extensively in the health care system. When dialysis machines were conceived and first put to use (and believe me they were incredibly primitive) they were used for patients who had suffered acute renal failure. That is, their kidneys had quit working, but temporarily, probably as a result of another condition. The dialysis machines were not used for chronic--that is, permanent--renal failure. In addition, hospitals only had 1 or 2 machines. Therefore doctors' panels would convene to decide who would get dialysis treatment and who would not. Without the treatment, unless the patient's kidneys spontaneously restarted, the panel was consigning patients to death. Doctors and nurses referred to these panels as "death panels."
Now the interesting thing is that Teddy Kennedy successfully got Medicare Part B to cover ESRD (End Stage Renal Disease) patients, making the kidney the only entitled organ in the body. (People on Medicare probably skip the portions on ESRD in their "Medicare and You" books, but it is there.) At the time ESRD coverage passed, dialysis was still just used for acute patients, and was cheap. The fact that there was a governmental program reimbursing health care entities for dialysis created a new industry. For-profit centers were formed with many more machines, which at the same time were constantly improving. These for-profit centers were able to start providing treatment not only to patient with acute renal failure, but now also those with chronic renal failure. Today, there are ESRD chains, the largest in the world has 1,700 clinics in the U.S. alone. ESRD coverage has come to represent 8-10% of the Medicare budget even though the patient population is tiny. Each patient uses $60,00-$70,000 in dialysis services per year.
The profit motive, though catalyzed by Medicare, solved the problem of "death panels" in our hospitals. Of course, the concept of death panels is not limited to end stage renal disease patients. Many doctors have been required to participate on panels that decide whether treatments ought to be used for patients. However, the phrase "death panel" was used explicitly and commonly with regard to ESRD. Is it stupid, therefore, given the role of the profit motive in extending dialysis treatments to the chronically ill, to ask what will happen when the profit motive is mitigated?
Why should journalists automatically assume that Sarah Palin is too stupid to know anything about health care. As the governor of Alaska would she not have been responsible for the state's Medicaid program? Does Medicaid work differently in Alaska than in the rest of the states? Which of the 9 Medicare regions does Alaska belong to? Could she perhaps be familiar with Medicare programs? Given that she has a child with Downs Syndrome, isn't it possible that she's spent enough time in hospitals to have learned some of the hospital lingo? Even if Sarah Palin knows nothing of the history of "death panels" those who laugh at her for using the term, especially journalists, are showing their own ignorance of a true health care problem.
Subscribe to:
Comments (Atom)