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RE: The US Healthcare System..........anyone? - 9/26/2011 6:51:42 AM

Aylee

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quote:

ORIGINAL: tazzygirl

quote:

The two points are related to preventative medicine.

Preventative medicine isnt just about bad habits.

Primary prevention Primary prevention strategies intend to avoid the development of disease.[7] Most population-based health promotion activities are primary preventive measures.

Secondary prevention Secondary prevention strategies attempt to diagnose and treat an existing disease in its early stages before it results in significant morbidity.[8]

Tertiary prevention These treatments aim to reduce the negative impact of established disease by restoring function and reducing disease-related complications.[9]

Quaternary prevention This term describes the set of health activities that mitigate or avoid the consequences of unnecessary or excessive interventions in the health system.[10]

Well, hell, there are FOUR types of prevention? And all this time I thought I was doing well following the food pyramid and making sure that Betterhead and I got fresh air and sunshine.

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Post #: 21

RE: The US Healthcare System..........anyone? - 9/26/2011 10:31:23 AM

Lockit

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Medicaid and Medicare are different things. Medicaid is for families that are poor basically, but you must have a child under the age of eighteen in the home to get it. Single people cannot get it. They may be able to get something their state provides to make up for this lack or discrimination, but that is rare.

Medicare is for those that are ON disability. Proving with a doctor or many doctors isn't enough to prove you are disabled. You must be on disability to get it or be elderly and retired.

I have gone over this with many political leaders, social security and social services. I have argued with a number of them and not stopping until I got them to admit, their wording amounts to what I have just said here. They want people to think they provide when they do not because it causes less trouble for them and people are more positive with them or they get less hassles from people, if people think their tax dollars are really helping those that need assistance.

Say you are working and have work hour credits amounting to the minimum you must work to get disability, which is basically 2 out of the last five years, but there are also certain conditions to that. You would get proper disability. If you don't have the work hour credits, you can apply for SSI, which is what I call the welfare system of social security. You get very little. Each of these things can take many years to get. So you are disabled somehow, you must apply for either of these programs unless you have children in the home, in which case, you can apply for welfare or TANIF and will get medical coverage through Medicaid or whatever your state might call it. If you do not have children, you get no medical coverage for your disability and must wait until you are approved for some sort of social security disability. Some states do have help after you have applied for this disability, many do not. This help would include food stamps and a small bit of cash. Some states as little as one hundred dollars to say five hundred and thirty dollars, basically. Some states have absolutely nothing.

Some area's have clinics for the poor. Some have clinics for migrant workers that they allow poor Americans to go to but are started and funded for migrant workers. You don't always get good care there and they are often times hard to get into time wise, you better know how to word things to get in right away if you can, or you are told to go to an emergency room. These clinics go on a sliding scale fee and most often are based on your tax returns. If you have no tax returns for that year because you have been disabled and haven't worked while waiting for disability, you can show them papers for that application or other ways to prove you aren't working, but good luck with that. It can be real tricky.

So if you have an illness the doctors don't understand, you can be in limbo and this happens far more often than you might know about. I was stuck in limbo waiting for enough to file disability for fifteen years. I still cannot find a medical team that understands my illness or illnesses and knowing the social security handbook as I do... even having won a few battles with lawyers trying to get people's money presenting the facts in a faulty manner... you can get a final no if you go at it the wrong way. The lawyers will say.. that isn't true... come with me, I will help you. Guess what? The longer you are their client and not on disability... the more money they make. You tell me... which do you think most will do? Help you right away and make 4% of a few months payment to you or let you go the two to four or even six years and collect 4% of all those years of payments? The percentage could be different, but I am using that as an example.

Some do not fit between the lines and will fall through the cracks in a faulty system that was never created to actually work well.

Now... because of current laws being changed.. some facts may be changing, but many are still trapped without much care at all and with no one really advising them properly what is in their best interest.

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Post #: 22

RE: The US Healthcare System..........anyone? - 9/26/2011 10:42:26 AM

LadyHibiscus

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It is very hard to get Medicaid in Michigan if you are not handicapped/disabled or have minor children.

A friend was able to get into a program for low income people through his gf's SIL. He was in the hospital for a MONTH. A freakin MONTH. Now he's at home on TPN until they decide about surgery. He has a phenomenal case of pancreatitis, psuedocysts bigger than the actual pancreas. Pure luck that he was able to get care.

It's nasty for the sick.

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Post #: 23

RE: The US Healthcare System..........anyone? - 9/26/2011 11:03:39 AM

Lockit

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LadyHib, I have seen in very few cases, someone getting emergency medicaid or medicare. It depends on the state and sometimes fraud. If someone in social services is rubbing the back of someone in a hospital system or the system itself, some things can be paid for. I know CA used to have emergency medicaid for the homeless if they had to be hospitalized. I do believe in part this was a deal to keep hospitals from going under... not as a provision for the needy.

In some cases, I believe... not know for sure in all cases... that some hospital bills have been covered for those that didn't qualify according to the rulebook, but if you look deeply, you can find out why or suspect why it was paid. Typically it was the powers that be covering for the other powers that be. My son's hospital bill should not have been covered because he wasn't on disability and he wasn't under eighteen. He would surely, eventually be covered by disability. His hospital bill was huge. I am talking from death back to life and months in hospitals within the same hospital system. This hospital system had special protections by the state and to sue them you had to ask permission from the state within a couple months... which few knew the rules to. They got paid. They shouldn't have been. The hospital was paid, he didn't have medical coverage after that until he was approved for disability for a brain injury and needing total care, for over two years after that.

I couldn't apply for disability for decades. I may now be in a position to apply, but cannot find a medical team to help me do it. I go down and we will see what happens I guess, unless some laws have changed. I will be out there finding that out soon. lol

< Message edited by Lockit -- 9/26/2011 11:04:09 AM >

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Post #: 24

RE: The US Healthcare System..........anyone? - 9/26/2011 11:20:25 AM

tazzygirl

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Lockit

In PA, all I had to have was a form from the DR saying I was unable to perform my job and I was eligible for Medicaid... the diability is short term. If it goes into a year, or is expected too, then SSI kicks in.

Each state is different as far as these rules go.

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Telling me to take Midol wont help your butthurt.
RIP, my demon-child 5-16-11
Duchess of Dissent 1
Dont judge me because I sin differently than you.
If you want it sugar coated, dont ask me what i think! It would violate TOS.

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Post #: 25

RE: The US Healthcare System..........anyone? - 9/26/2011 11:28:09 AM

Lockit

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quote:

ORIGINAL: tazzygirl

Lockit

In PA, all I had to have was a form from the DR saying I was unable to perform my job and I was eligible for Medicaid... the diability is short term. If it goes into a year, or is expected too, then SSI kicks in.

Each state is different as far as these rules go.

Did you have children in the home? When was this? If medicare comes into it, you must be on SSI. You have been approved for a temporary disability. If it continues, you still have to be approved for permanent disability... which is SSD or SSI. SSI means you haven't worked enough work hour credits. What they tell you and what will actually happen are two very different things often times. The social security program is a federal program, the rules don't change by state. If anything is changed, it is the states doing and funding or fraud.

Some states do have conditions that they have done on their own... few allow it though, because the federal program doesn't pay for it and it has to come from their state pocket.

Unless some major things have changed with the Obama care stuff.

PS Tazzy... I would bet money it was a social worker that told you the medicare or SSI would kick in if your disability lasts longer than a year. This is correct... but misleading. It is not automatic. What they failed to mention was that SSI would have to kick in and failed to tell you the process for which it would kick in. It's all in how they are taught to word it.

< Message edited by Lockit -- 9/26/2011 11:37:35 AM >

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No matter how old a woman gets, some men will think she was born yesterday! ROFL... I love this place!

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Post #: 26

RE: The US Healthcare System..........anyone? - 9/26/2011 11:56:01 AM

tazzygirl

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When? Now.... cant work because of achilles tendonitis... and no kids in the home.

The state of Pennsylvania adds money to the federal SSI payment. A single payment which includes both the federal SSI payment and the supplement from Pennsylvania is issued to residents of domiciliary care homes and personal care boarding homes.

If you live independently, in someone else’s household or in a Medicaid facility, you receive a separate payment from Pennsylvania in addition to your federal SSI payment.

http://www.ssa.gov/pubs/11150.html

From my understanding. Medicaid would still be the insurance.

_____________________________

Telling me to take Midol wont help your butthurt.
RIP, my demon-child 5-16-11
Duchess of Dissent 1
Dont judge me because I sin differently than you.
If you want it sugar coated, dont ask me what i think! It would violate TOS.

(in reply to Lockit)

Post #: 27

RE: The US Healthcare System..........anyone? - 9/26/2011 11:59:59 AM

tazzygirl

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Oh, SSA is based upon credits, SSI isnt.

The SSI program is managed by the Social Security Administration (SSA), but financed by the general tax fund. Because the program is not financed by Social Security taxes, there are no work requirements necessary to qualify for SSI.

http://www.socialsecurity-disability.org/content/about-ssi?utm_source=bing&utm_medium=cpc&utm_term=ssi%2520pa&utm_content=806746793&utm_campaign=8814825817

_____________________________

Telling me to take Midol wont help your butthurt.
RIP, my demon-child 5-16-11
Duchess of Dissent 1
Dont judge me because I sin differently than you.
If you want it sugar coated, dont ask me what i think! It would violate TOS.

(in reply to tazzygirl)

Post #: 28

RE: The US Healthcare System..........anyone? - 9/26/2011 12:45:33 PM

Lockit

Posts: 11292
Joined: 5/7/2007
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quote:

ORIGINAL: tazzygirl

When? Now.... cant work because of achilles tendonitis... and no kids in the home.

The state of Pennsylvania adds money to the federal SSI payment. A single payment which includes both the federal SSI payment and the supplement from Pennsylvania is issued to residents of domiciliary care homes and personal care boarding homes.

If you live independently, in someone else’s household or in a Medicaid facility, you receive a separate payment from Pennsylvania in addition to your federal SSI payment.

http://www.ssa.gov/pubs/11150.html

From my understanding. Medicaid would still be the insurance.

This may be something I have forgotten... but you were approved for SSI, for one year which entitles you to medicaid. SSI may be covered by medicaid rather than medicare, I don't remember. I know disability SSD is covered with medicare, so I may have misspoken in my earlier post when I said SSI is covered by medicare... the difference could be the temp or perm disability or SSI rather than SSD. SSD and SSI are federal and until approved you cannot get medical coverage unless it is a state thing or you have children in the home or are in a facility.

You were approved for temp SSI. When your year is up, you will have to be re-approved and may have to apply for perm SSI, which if approved you could continue with the medicaid, not the medicare you said would kick in after that year. This is very situational because of whatever the persons circumstances are. Medical from medicaid to medicare doesn't simply kick in without the application process for a perm disability. The question I now have is and cannot remember... sorry I've had strokes... would be whether those on perm SSI get medicaid or medicare. That would take too much digging for me to do today.

If you were not approved for SSI, had no children in the home and were not in a facility or the medical community could not determine you were going to be disabled for a year or more, you would not get medical assistance unless it was a state provision beyond what the federal programs do.

The yearly disability by way of SSI or SSD is really hard to get. You had one hell of a doctor and reports or your state has a great way of working that. Some states do work differently in accessing the federal programs depending on a few things... work load, number of applicants, etc.

See, if you apply for perm disability, you and your doctors are saying you will be disabled for more than a year. However... many cannot get that SSI or SSD that first year. Most don't. You were very lucky. Most are denied the first application and must reapply. This is within three months of your application. Then you reapply and without any funds from the federal program... must wait two years for a hearing. Most of the time... these people are without any funds whatsoever... but they fall into that year disability time. So why couldn't they get help? That's the question. lol

You do live in one of the states that provide more. CA used to be and still may be another. There are some others, but I can't remember them at the moment. Sorry, I have a headache.

< Message edited by Lockit -- 9/26/2011 12:46:30 PM >

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No matter how old a woman gets, some men will think she was born yesterday! ROFL... I love this place!

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Post #: 29

RE: The US Healthcare System..........anyone? - 9/26/2011 1:01:58 PM

tazzygirl

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No, I am temp disabled for 6 months.... Medicaid picked that up.

_____________________________

Telling me to take Midol wont help your butthurt.
RIP, my demon-child 5-16-11
Duchess of Dissent 1
Dont judge me because I sin differently than you.
If you want it sugar coated, dont ask me what i think! It would violate TOS.

(in reply to Lockit)

Post #: 30

RE: The US Healthcare System..........anyone? - 9/26/2011 1:14:44 PM

Lockit

Posts: 11292
Joined: 5/7/2007
Status: offline

quote:

ORIGINAL: tazzygirl

Oh, SSA is based upon credits, SSI isnt.

The SSI program is managed by the Social Security Administration (SSA), but financed by the general tax fund. Because the program is not financed by Social Security taxes, there are no work requirements necessary to qualify for SSI.

http://www.socialsecurity-disability.org/content/about-ssi?utm_source=bing&utm_medium=cpc&utm_term=ssi%2520pa&utm_content=806746793&utm_campaign=8814825817

Right. If you need disability and have work hour credits, you can get SSD. If you don't have the work hour credits, you can apply for SSI which is based on not having work hour credits, income base or lack thereof and need. Which is what I called the welfare system of social security because it helps so little. SSA is something that used to be provided by states and was called different things, like in CA it was called General Relief, but it seems to be currently paid by social security, basically an increase of a few bucks per month if one qualifies under the SSI guidelines for this supplement.

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No matter how old a woman gets, some men will think she was born yesterday! ROFL... I love this place!

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Post #: 31

RE: The US Healthcare System..........anyone? - 9/26/2011 1:26:20 PM

Lockit

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Joined: 5/7/2007
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quote:

ORIGINAL: tazzygirl

No, I am temp disabled for 6 months.... Medicaid picked that up.

I'm sorry I misunderstood the terms used here. I was under the impression you were on SSI disability for one year, not going through social services. Because of this, I thought you were saying medicaid would turn to SSI medical coverage.

Because of the Obama care changes... medicaid may have some new guidelines... which I am going to be finding out soon.

https://www.cms.gov/medicaideligibility/

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No matter how old a woman gets, some men will think she was born yesterday! ROFL... I love this place!

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Post #: 32

RE: The US Healthcare System..........anyone? - 9/26/2011 1:30:36 PM

tazzygirl

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Joined: 10/12/2007
Status: offline

Each state is different.. and there have been changes. Would definitely be in your best interests to go.

_____________________________

Telling me to take Midol wont help your butthurt.
RIP, my demon-child 5-16-11
Duchess of Dissent 1
Dont judge me because I sin differently than you.
If you want it sugar coated, dont ask me what i think! It would violate TOS.

(in reply to Lockit)

Post #: 33

RE: The US Healthcare System..........anyone? - 9/26/2011 1:41:32 PM

AneNoz

Posts: 263
Joined: 4/26/2011
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The system of insuring I do not understand, it is too complex. When first we arrived in America, we did inquire about such insurance and the complexity was too much. It is insanity, it was far more simple to but pay for what we required.

Beyond this, the medical services of itself is superb, it is second to none. The resources and skills and treatments made available are, beyond questioning, far beyond what is offered in Europe. If one can pay or can determine how to be insured, then the system is beyond compare, but how one is to pay is a question that should be of grave concern to all within this country. I will grant that I have purchased for my Beloved Miryam all that could be asked and only of the best, and that perhaps I may have needed less or perhaps might have found alternatives of a less expensive nature, but this the cost of this care has exceeded many, many thousands of dollars to date. How a person of lesser means might deal with such an expense in such an eventuality is beyond my ability to comprehend.

I fear for many in this country on this account.

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Post #: 34

RE: The US Healthcare System..........anyone? - 9/26/2011 2:01:05 PM

Lockit

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Okay, I did some digging, googling and called Social Services and had a nice long talk that wasn't so nice... fat chance of my getting medicaid. lol Single adult thing. Even with a long history of disability, without being on SSI, I cannot get it.

They said there is a slight chance that if I applied for SSI and had a very bad situation medically speaking... which I do, but they don't know about this disease and it isn't taught in America... and the other illnesses wouldn't qualify... I could get some help temporarily... but you really have to be in a very bad situation they recognize. She said you can apply, but rarely would you get it.

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Post #: 35

RE: The US Healthcare System..........anyone? - 9/26/2011 2:12:18 PM

agirl

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FR...

Thanks for talking about this. I still find it rather complicated and difficult to understand. I equate it to our home insurance for example, where we have to read the small print in detail to know exactly what's covered and have to shop around to be covered for everything. ( mostly I don't read the small print in that much detail as losing a carpet or freezer isn't a big deal in the great scheme of things....lol)

It seems to be a very complicated way of looking after health having spent a lifetime with the NHS here in the UK. To make matters even more tricky the varying rules from state to state must make moving a nightmare.

What do you all think about a universal system such as the NHS?

Would it even be operable within the US with the laws differing from state to state and with the size of the US?

Is the average US person averse to paying an amount at source from their wages, as we do here? ( An online aquaintance in SC said that he wouldn't want to do this as he'd be paying for other people's care, some of whom might be wasters...lol)
We do this fairly stoically as we also benefit.

Thanks again for all the explanations and discussion.

agirl

My daughter has had two strokes (first one at 23yrs, the second a few months ago at 26yrs) and is about to undergo a huge series of tests in a leading hospital meaning a week long stay as an inpatient. Currently she sees at least four specialists ...I can't imagine how we'd be able to afford this extensive care with the US system.

agirl

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RE: The US Healthcare System..........anyone? - 9/26/2011 2:23:28 PM

Lockit

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agirl, do strokes run in your family? If so and maybe even if not... please google Cadasil. It is a rare genetic disease, can look like MS on the brain and causes mild strokes. It took almost three decades and lots of money and destroying my career and life to find that one. Anytime I hear of multiple strokes and they don't know the cause, I recommend looking into this as most doctors world wide don't know about it.

There are some cases that have been showing up without a medical history of it. Basically there is a problem in the notch 3 and maybe notch 6 of the DNA code.

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No matter how old a woman gets, some men will think she was born yesterday! ROFL... I love this place!

(in reply to agirl)

Post #: 37

RE: The US Healthcare System..........anyone? - 9/26/2011 2:57:05 PM

Iamsemisweet

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From: The Great Northwest, USA
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I would guess most people in the States find our health care system, particularly insurance, to be complicated and difficult to understand.

I think a universal system like the NHS would be a great idea. Unfortunately, suggesting such a thing is considered "socialism", which is a dirty, filthy word in this country. IN fact, there was recently a huge and acrimonious debate about the healthcare issue in the US, that resulted in the creation of a system that I believe will be even more complicated and difficult to understand than the one we have now! Nevertheless, I believe we have taken our first step towards a National healthcare system. At least I hope so.

quote:

ORIGINAL: agirl

FR...

Thanks for talking about this. I still find it rather complicated and difficult to understand. I equate it to our home insurance for example, where we have to read the small print in detail to know exactly what's covered and have to shop around to be covered for everything. ( mostly I don't read the small print in that much detail as losing a carpet or freezer isn't a big deal in the great scheme of things....lol)

It seems to be a very complicated way of looking after health having spent a lifetime with the NHS here in the UK. To make matters even more tricky the varying rules from state to state must make moving a nightmare.

What do you all think about a universal system such as the NHS?

Would it even be operable within the US with the laws differing from state to state and with the size of the US?

Is the average US person averse to paying an amount at source from their wages, as we do here? ( An online aquaintance in SC said that he wouldn't want to do this as he'd be paying for other people's care, some of whom might be wasters...lol)
We do this fairly stoically as we also benefit.

Thanks again for all the explanations and discussion.

agirl

My daughter has had two strokes (first one at 23yrs, the second a few months ago at 26yrs) and is about to undergo a huge series of tests in a leading hospital meaning a week long stay as an inpatient. Currently she sees at least four specialists ...I can't imagine how we'd be able to afford this extensive care with the US system.

agirl

_____________________________

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Alice: How do you know I'm mad?
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Post #: 38

RE: The US Healthcare System..........anyone? - 9/26/2011 4:17:19 PM

agirl

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quote:

ORIGINAL: Lockit

agirl, do strokes run in your family? If so and maybe even if not... please google Cadasil. It is a rare genetic disease, can look like MS on the brain and causes mild strokes. It took almost three decades and lots of money and destroying my career and life to find that one. Anytime I hear of multiple strokes and they don't know the cause, I recommend looking into this as most doctors world wide don't know about it.

There are some cases that have been showing up without a medical history of it. Basically there is a problem in the notch 3 and maybe notch 6 of the DNA code.

No, she is the only person in the family to have had strokes.....but something you just said has alarmed me. I had a scan on my head recently for an ENT problem and was passed on to a Neurologist as the scan showed the same demyelination as in MS....... I have no physical symptons though. I was told that the pattern in my brain is the same as in MS.

As the specialists have been through every syndrome known, with my daughter, they are now looking at cutting edge research to find the answer for her strokes.....also exploring heart problems. I shall see what I can find on Cadasil. And thanks very much.

agirl

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Post #: 39

RE: The US Healthcare System..........anyone? - 9/26/2011 8:06:01 PM

LafayetteLady

Posts: 7683
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From: Northern New Jersey
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I received medicaid in NJ without a dependent child and it wasn't a struggle to get. Of course it was "plan G" which doesn't include hospitalization but did cover my medications which cost about $700 a month.

Worst thing is it is adminstered by county and so I haven't been able to reapply in the new county which lacks transporation options. Haven't had the necessary diabetes meds, fibromyalgia meds, proper follow up for kidney failure or pain management for my back injury. My cousin works for a pain management doctor and gets me samples of some things for my back, but I have to be very careful because of my kidneys.

Healthcare in the US leaves much to desired. Yes, we have great advancements but insurance companies fight to keep from having to pay for them. Then we have people like the guy in SC who does not want a national system because he is worried about "wasters." Not a funny guy and honestly, someday if he needs something major, I hope his insurance denies him and he finds out what other people go through. Being the poster child for ignorance is not a positive personality trait.

For me, so many other countries have a system that works. Sure, we have folks on here who complain about them, but they are the ones who tend to complain about everything so their opinions tend to have little merit. system because he is worried about "wasters." Not a funny guy and honestly, someday if he needs something major, I hope his insurance denies him and he finds out what other people go through. Being the poster child for ignorance is not a positive personality trait.

For me, so many other countries have a system that works. Sure, we have folks on here who complain about them, but they are the ones who tend to complain about everything so their opinions tend to have little merit.

(in reply to Lockit)

Post #: 40

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