Medicare as a shining example

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OrionTheWolf -> Medicare as a shining example (8/17/2009 11:41:08 AM)
Well people like to show Medicare as a great example of how the Government handles healthcare. True story that just occured: My Mom has COPD and is bed confined. She moved a couple of steps to a bedside commode and back a few times a day. All of her energy is spent to breath. She is on an oxygen machine, and has been on one for seven years. COPD will never get better, it is degenerative and will eventually cause death. She had to have her machine replaced recently. Medicare is requiring she see her General Practioner for a certificate of medical necessity. Now she had this done when she got the first machine, and remember COPD does not get better. I spoke with Medicare and explained to them that she requires medical transportation to go to the doctor, and since she also has heart issues it is required to be a fully equipped ambulance. Not to mention going to the doctor takes a lot of energy out of her, and about half the time in the past she has to go into the hospital for a few days to weeks within a couple of days of going. Medicare is aware of all of this. They are fully aware of the condition she has. They are fully aware this could be detrimental to her health. They will not pay for a home visit, and must go to the doctor. This is even though she went 6 months ago, because Medicare required it again so they would continue to pay for her prescriptions. So now just so that the red tape is done properly, all the T's are crossed and I's dotted, Medicare is going to spend out about a grand, for the certificate of medical necessity. Any review of my Mom's medical records by anyone with even medical knowledge would see it is required. All i can assume is that since they feel this money does not really belong to anyone, then spending it in such a manner, as well as doing something that may be detrimental to the patient when it is unneeded, is perfectly acceptable. Sorry but things like this keep me doubting the government could effectively handle universal health care. Not how our government is now at least. Also, I believe the Medicare budget is in trouble, so why do they force expenditures that are clearly unneeded? We are not going to find any solutions to anything until the polticians are forced to change how they operate, and how they have the government operate.

Termyn8or -> RE: Medicare as a shining example (8/17/2009 9:12:11 PM)
Don't take the lack of responses as a negative reponse. Many might be thinking about what I am thinking. I don't know what to say. T

OrionTheWolf -> RE: Medicare as a shining example (8/18/2009 5:21:04 AM)
I have been reading some forums for the elderly, and some of their stories concerning what Medicare requires them to do in some situations is ridiculous, and a waste of money. Since being directly involved in everything concerning my parents health, I keep getting surprised by the health care system and Medicare. The other things I do not understand is why Medicare is automatically primary. My Dad pays out of his retirement for an Aetna full health plan and is retired Military, so he has Tricare as well. It is like they set the system up to give insurance companies a break, and spend our tax dollars first.

Rule -> RE: Medicare as a shining example (8/18/2009 5:37:07 AM)
Perhaps you as a concerned tax payer can sue them, or the politician responsible?

flcouple2009 -> RE: Medicare as a shining example (8/18/2009 5:40:09 AM)
Because that was how the private insurances got it structured once upon a time. Most of those plans are secondary, with a cap on benefits, and they send you through Medicare before they pay. I saw my Dad's insurance work the same way. Sorry for the trouble it is hard to watch, but a lot of private insurance groups make people jump through the same hoops.

elegantcdgoddess -> RE: Medicare as a shining example (8/18/2009 7:54:43 AM)
i dont think that is medicare issue. The problem is in healthcare. Why dont we have physicians with regular home visits in US? I know it might sound harsh, but there is nothing wrong with medicare decision. Elderly, ill patients should see physician and be evaluated, rather then medicated blindly. That is actually great concept. The problem is in healthcare system who cannot organize themself to serve the patient.

olena -> RE: Medicare as a shining example (8/18/2009 7:55:26 AM)
Anecdotal stories are quite meaningless. There are and will always be plenty of bad and horrific stories whenever you have any human involvement in something. Personally I do not understand why one thinks a for profit company has the best interest of a person, especially older more likely to be way more costly, over a non profit one like Medicare. Both are going to screw up and make people feel like they do not really care but at least one does not give out bonuses to people for denying claims.

Musicmystery -> RE: Medicare as a shining example (8/18/2009 8:20:48 AM)
quote: people like to show Medicare as a great example of how the Government handles healthcare. Actually, it's an example of the ONLY time (until the Prescription Drug plan) government addressed healthcare. Is it perfect? Nowhere near. It needs fixing--even more so than Social Security. But compare the situation before Medicare/Medicaid to now. Night and day. I don't think you'd want to go back. Handling will always involve mishandling as well. But the perfectionist fallacy isn't going to solve the crisis--and I do mean crisis, economically--we're headed for if we don't address national health care. Maybe then we'll wake up and fix Social Security and Medicare/Medicaid before those become crises too. I agree that anecdotes aren't particularly helpful divorced from the arguments they purport to illustrate. Someone will always find a story of how not wearing a seatbelt saved a life. Doesn't change that safety restraints save lives--thousands. Same thing here. We have to address health care--for mountains and mountains of reasons getting worse every day.

OrionTheWolf -> RE: Medicare as a shining example (8/18/2009 10:13:15 AM)
Actually Medicare is not even a non-profit, they are a government agency. This means they can spend beyond their means, not have to worry about saving money, and have little accountability. Actually anecdotal stories are the most relevant information on whether a process works or not. They are the facts that are occuring, and not some rating of approval. This is why congress has hearings where people that go through specific situations testify. What my story was illuminating is that our government does not care to save money, it is evident. As long as Reps and Dems bicker about bullshit, and their supporters continue to support them for bickering about bullshit, things will remain fucked up. At least one cares to try and keep expenses down. Now balance things between the two and stop accepting that this is the way it has to be, because it does not. quote: ORIGINAL: olena Anecdotal stories are quite meaningless. There are and will always be plenty of bad and horrific stories whenever you have any human involvement in something. Personally I do not understand why one thinks a for profit company has the best interest of a person, especially older more likely to be way more costly, over a non profit one like Medicare. Both are going to screw up and make people feel like they do not really care but at least one does not give out bonuses to people for denying claims.

OrionTheWolf -> RE: Medicare as a shining example (8/18/2009 10:23:23 AM)
Actually Tim many state governments have handled healthcare in several areas for years. They do so with a lot less cost than the Feds use, and I am not talking about just Medicaid either. Health Departments with lower costs on various basic medical procedures. Also, this is an example of how a government agency is more concerned about following regs, rather than review those regs for cost saving potential. Even an amputee has to get a CMN for any replacement equipment, so Medicare even requires them to go to the Doctor to say 'Nope the limb still has not grown back yet, he really needs the wheelchair replaced." So what are the incentives for a government agency to spend less money?

Musicmystery -> RE: Medicare as a shining example (8/18/2009 11:40:45 AM)
quote: Actually anecdotal stories are the most relevant information on whether a process works or not. They are the facts that are occuring, and not some rating of approval. This is why congress has hearings where people that go through specific situations testify. I can't agree. They deserve consideration. But "most relevant"" Surely a handful of stories isn't the truest indication. They may well be sufficient reason for a more inclusive search--that would be most relevant. I also have trouble with the "whether a process works or not" characterization. My mechanic, fortunately, focuses on whether my car works well, and makes adjustments as need, rather than scraping it when it needs maintenance or repair. I do agree that government agencies follow regulations as a principle over maximizing profit as a business would. That's why they were created in the first place, rather than allowing business to handle the matter. Much as I like markets, those markets have externalities, and until someone thinks up something better, externalities will have to be handled by government. The litigious nature of our society doesn't help much either.

DemonKia -> RE: Medicare as a shining example (8/18/2009 12:40:56 PM)
FR, after read thru So, I'm not sure what the alternative is that the OP thinks will actually happen if there was no MediCare / government interference in health-care provision . . . . . Patients paying for care out of pocket? Getting to experience first-hand the joys of private insurance dumping expensive customers to maintain profit margins? Medicine only for those who can pay? Those seems like far more problematic choices . . . . . & I note that the French health-care system has doctors who do house calls . . . . . (Sorry, no link, read it sometime in the last coupla years . . . .. ) Ah. & as to the resolution of the kind of problem raised in the OP: the various other 'universal' & / or 'single-payer' health-care systems in place in the other industrial & developing countries tend to do a better job of controlling costs on all kinds of levels . . . . . . (& yep, it's not just wealthy countries, even relatively poor countries, such as much of Latin America. Also, China & India, which strikes me as kinda profound . . . . ) Notably these systems are having better outcomes in both quality & cost controls with regard to issues such as anti-biotic resistant bacterial infections (particularly Northern Europe, Europe in general, Australia, New Zealand, & Canada) . . . . . With generally some kind of centralized decision making about the greatest cost-benefit advantage based on the emerging science & resultant 'best practices' thinking by the relevant experts . . . . . & that last bit is the dreaded 'rationing', or can be construed as that demonized construct, 'rationed care' . . . . . Medical care, like any other resource, is limited from the get-go. Medical care is limited by the knowledge / skill base of the practitioner, the various tools available, the cultural system & the general fact base & so on . . .. . 'Best practices' is another fundamental limit on what health care is easily available, health-care practitioners follow standards of care that dictate in detail all kinds of diagnostic & medical procedures. & mostly that's a good thing, being based mostly on the current understanding of the science, & changing as our understanding & information changes . . . . . .

Louve00 -> RE: Medicare as a shining example (8/18/2009 3:07:07 PM)
I've been wanting to post on this thread, but was waiting for an article about this to post, but my impatience to wait is going to make me post now. [:)] I belong to an association called the Life Extension Foundation. In their Sept magazine issue they have their own proposal to reform health-care, but in that article was a perfect example of what you are speaking about. Take this example of waste, which you may be able to relate to..... An oxygen concentrator (according to this article I'm referring to) costs $600. By law, medicare is only allowed to rent a device like this, at a price that winds up costing, thru rental fees, (again, according to this article) costs $7,142.00 over a 36 month period. Medicare will cover $5,714 dollars of that and the patient will have to pay the other $1,428 (or 20%), when the concentrator costs $600 to begin with!! That is utterly rediculous, wasteful, and just *one* example in this article, which I will be able to post to you, if you want it, most likely when Sept gets here. But the article goes on to tell you about a whole bunch of completely absurd wasteful spending that is going on.

DomKen -> RE: Medicare as a shining example (8/18/2009 3:22:30 PM)
Basic question for those attacking Medicare, what would seniors do without it? Would you be willing to right now permanently opt out of both mecicare and SS if they are such terrible freedom destroying socialist programs?

Vendaval -> RE: Medicare as a shining example (8/18/2009 3:31:24 PM)
Orion, I am sorry about the problems your mom is having with Medicare. My family has also had our problems with navigating and negotiating the red tape of both Medicare and the VA. Both need an overhaul but are better than not having any system in place at all. There is so much work to be done here in the US on the whole health care system. I am relieved that at last a public and political dialogue is happening and realize that this is going to be a long, on-going process that requires the average citizen to take notice and make their voice heard on all levels of government. Peace, Vendaval

Musicmystery -> RE: Medicare as a shining example (8/18/2009 3:35:11 PM)
quote: ORIGINAL: DomKen Basic question for those attacking Medicare, what would seniors do without it? Would you be willing to right now permanently opt out of both mecicare and SS if they are such terrible freedom destroying socialist programs? If we applied the same reasoning to pentagon overexpenditures, we'd be arguing for the dissolution of the military.

OrionTheWolf -> RE: Medicare as a shining example (8/18/2009 3:41:16 PM)
This is an example of a ridiculous reply, utterly ridiculous. I am not talking about getting rid of Medicare, and I do not believe anyone else is, so your bullshit strawman does not stand up, it just stinks. What is be discussed is the wastefulness of that system, which seems to be inherent of our government. Change the system, fix what is broken, don't keep adding on to a foundation that is obviously faulty and dangerous. quote: ORIGINAL: DomKen Basic question for those attacking Medicare, what would seniors do without it? Would you be willing to right now permanently opt out of both mecicare and SS if they are such terrible freedom destroying socialist programs?

OrionTheWolf -> RE: Medicare as a shining example (8/18/2009 3:42:50 PM)
This is what my Mom is getting, and not only does she have to rent it, as you have shown here, but the extra cost of the Doctor's visit to say "yep she still has an incurable disease, and yep she still needs an O2 concentrater like the last time I signed a CMN.". quote: ORIGINAL: Louve00 I've been wanting to post on this thread, but was waiting for an article about this to post, but my impatience to wait is going to make me post now. [:)] I belong to an association called the Life Extension Foundation. In their Sept magazine issue they have their own proposal to reform health-care, but in that article was a perfect example of what you are speaking about. Take this example of waste, which you may be able to relate to..... An oxygen concentrator (according to this article I'm referring to) costs $600. By law, medicare is only allowed to rent a device like this, at a price that winds up costing, thru rental fees, (again, according to this article) costs $7,142.00 over a 36 month period. Medicare will cover $5,714 dollars of that and the patient will have to pay the other $1,428 (or 20%), when the concentrator costs $600 to begin with!! That is utterly rediculous, wasteful, and just *one* example in this article, which I will be able to post to you, if you want it, most likely when Sept gets here. But the article goes on to tell you about a whole bunch of completely absurd wasteful spending that is going on.

Musicmystery -> RE: Medicare as a shining example (8/18/2009 3:44:44 PM)
Orion, I think it's just a misunderstanding. Honestly, I read your OP the same way. I think everyone is open to changes to improve the bureaucratic waste. What do you propose? Live well, Tim P.S. -- Often, I think bureaucratic nonsense creeps up. A procedure to prevent abuse, a safeguard for patients, a compliance with another regulation....they add up, and become misapplicable to situations the rules didn't foresee. Add to this individuals protecting their little piece of turf, their tiny one desk kingdom in the system. I've seen this plenty of times not only in government and academia, but in business too--as I'm sure you have as well. There's no reason...it's just how we do things here. A culture of compliance springs up instead of one allowing for independent problem solving. People who buck this system are punished.

OrionTheWolf -> RE: Medicare as a shining example (8/18/2009 4:00:29 PM)
I propose what I always have, and that is holding our politicians accountable. A complete review of Medicare, and the waste that goes on there would be in order. Hell the money we save there would pay for some kind of healthcare.

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