Medicaid is a program for individuals who can't afford to pay for medical care. You may be covered by Medicaid if you have high medical bills; you receive Supplemental Security Income (SSI); or you meet certain income, resource, age, or disability requirements.
This is the official idea behind Medicaid. It was designed to help take care of medical costs that you can't manage on your own due to one or some of the reasons above.
Medicaid differs a little from state to state. It's foundation is the same, however, it depends on the state's terms, conditions and budget.
The following is a description of Medicaid coverage in one particular state:
In general, the following services are paid for by Medicaid, but some may not be covered for you because of your age, financial circumstances, family situation, transfer of resource requirements, or living arrangements. Some services have small co-payments. These services may be provided using your Medicaid card or through your managed care plan if you are enrolled in managed care. You will not have a co-pay if you are in a managed care plan.
smoking cessation agents
treatment and preventive health and dental care (doctors and dentists)
hospital inpatient and outpatient services
laboratory and X-ray services
care in a nursing home
care through home health agencies and personal care
treatment in psychiatric hospitals (for persons under 21 or those 65 and older), mental health facilities, and facilities for the mentally retarded or the developmentally disabled
family planning services
early periodic screening, diagnosis, and treatment for children under 21 years of age under the Child/Teen Health Program
medicine, supplies, medical equipment, and appliances (wheelchairs, etc.)
clinic services
transportation to medical appointments, including public transportation and car mileage
emergency ambulance transportation to a hospital
prenatal care
some insurance and Medicare premiums
other health services
If you are eligible for Medicaid, you will receive a Benefit Identification Card which must be used when you need medical services. There may be limitations on certain services.
For you to use your Benefit Identification Card for certain medical supplies, equipment, or services (e.g., wheelchair, orthopedic shoes, transportation), you or the person or facility that will provide the service must receive approval before the service can be provided (prior approval).
The information above is a sample of what types of services a person can expect from Medicaid, and in many cases these services help provide what Medicare does not, so that the cost of medical care is not overwhelming for a senior or other individual.
If you think you qualify for Medicaid, contact your state's Medicaid office to begin the process of finding out. Even with budget cuts, Medicaid can help defer medical costs not paid by Medicare.
June 30th, 2009
There is a lot of controversy these days about what should go and what should stay in the huge U.S. budget which affects each state's and county's budget. Somewhere in that mirage of confusion, site Medicaid.
Though many of the proposed Medicare cuts and the ones already in progress are frightening and difficult, at best, to deal with, the thought of more Medicaid cuts puts more pressure on the people that need the program most.
Seniors and individuals with very low income often depend on Medicaid to get basic medical care. Nothing fancy or frilly. A few doctor's visits, maybe some tests and some medication. Medicaid is what is supposed to help these individuals who can't afford Medicare Supplements and who need to have regular medical care - even minimal care - to stay reasonably healthy.
When hearing what people on Medicaid have to say, they say it is a lifesaver - literally - in many cases. They say that without it they would be in a hospital somewhere very sick or dying at the state's expense. The unfortunate situation is that as budgets get leaner, criteria for people to qualify for programs gets tighter and more people who need this help are left out.
The problem is that rather than helping keep the benefits for people, once someone has lost them, the state and county end up paying untold thousands of dollars for emergency room visits that take the place of doctor visits. Keeping people on Medicaid and allowing new ones to get on it save the state and county money, short term and long term.
There is a lady who is 59 years old and lives with her children. Her only income is assistance since she is too young for Medicare and she has a disability that will probably continue the rest of her life. She has applied for Medicaid which she said was an escapade of jumping through hoops, and after she turned in every single paper (about 1/2 inch worth) she was denied. The woman can hardly walk. Her blood pressure is out of control, she has been in and out of the emergency room because her blood pressure has been so high they are worried about her having a stroke, and instead of accepting her to Medicaid to get the care she needs, she was turned away. So at age 59 she goes to sleep, fearful that she won't wake up, and there's nothing she can do unless things get so bad she goes back to the emergency room.
There are seniors that are worse off, who choose between groceries and medicine and use less of both, keeping them hungry, undernourished and undermedicated, while their condition gets worse.
In these times, it is understandable for cutbacks to happen. It is simply a matter that some of them don't make sense. In the richest country in the world we are letting seniors and others starve and suffer just to save a few dollars - and then it cost thousands more to care for the individuals anyway.
It is important for everyone to have a chance to feel as good as possible and get good care. Hopefully as budget cuts continue, the president and lawmakers will remember that there are people living on much less than $250,000 or even $25,000 per year through no fault of their own. It is important to think about their dignity and well being when putting programs on the chopping block.
June 30th, 2009
I saw this article while reading The Seattle Times. I read papers around the nation regularly to see what people have to say about the healthcare situation we are in as a nation. There are as many millions of opinions as there are people and lawmakers are playing tug of war with the situation. The problem with that -at least the biggest problem - is that they have the best healthcare in the world. If they get a hang nail, a hernia or a heart attack their healthcare will cover it. The rest of us who are not covered like that or not covered at all can be having a stroke going into the hospital and being questioned as to whether we have insurance or not while we can't hold our head up in a wheelchair. This happened to my friend just before she fell out of the wheelchair, had an aneurysm, went into a coma and died a month later. She was 42 years old.
Here is the story from The Seattle Times:
Then there are the common people like us. Some of us have no healthcare because we make just a couple of dollars too much for Medicaid. OK. If that is so, than let us pay the two
Richard H. Cooper wrote in The Seattle Times about the need to fix Medicare before letting government undertake another program.
I agree with all his points about improvements needed to this program. However, I believe there is a way to fix it and do health-care reform at the same time.
There's already House Bill 676, the new-and-improved Medicare Act. This bill will put everybody in Medicare, and as we know, the bigger the pool, the less the cost.
By having only one nonprofit financing mechanism for our health care, we can save huge amounts of money. Imagine all the premiums now going to for-profit insurance companies whose goal is to make as much money as possible, not make our population healthier.
Also by having one financing mechanism, we can save huge amounts of money for practitioner's by reducing administration and overhead costs.
Secure public coverage for all will also mean a lot of people will retire that now just work for health benefits, and some will start businesses and provide more jobs because the burden of health-care coverage is lessened.
We already have a mechanism for employers and employees to pay a Medicare tax, so it can easily be adjusted to cover all and substitute for paying premiums. And with a tax, one pays according to income as opposed to with a premium. It's a fair and simple way of reforming our health-care system.
But most important of all, this system gives us the most bang for the buck, and I do not want my tax dollars to subsidize for-profit health care.
Copyright © 2009 The Seattle Times Company
June 23rd, 2009
Recently, we have all been overwhelmed with talk about the proposed healthcare reform that many Democrats want to pass. President Barack Obama and volunteers that comprise of e-mail lists of the volunteers used during the elections and supporters of Barack Obama during the campaign have been on a major mission to pursuadepatients, doctors, and politicians to join them.
The idea is to “cover all Americans”, mostly through government mandates to purchase insurance.
We currently have little information but still, there are already many supporters of the plan, but some others are not comfortable with parts of the proposed plans. Many who support the plan bring up the fact that there are many in this country who are uninsured.
This is where Medicare and Medicaid come up.
Medicare is a system of insurance that assists the elderly who are eligible for social security payments. While no system is infallible, many who are on Medicare are satisfied with it. For the elderly who wish to get what they consider better care, they are able to get supplemental insurance from many private insurers, often at a discount. Many senior citizens choose this option, and many who live in a single-payer system would also prefer to supplement their insurance with this option. Medicare is also available to the disabled.
Medicaid is a health insurance program for low-income people. States are required to cover many that wish to have insurance whose income is at or below the poverty level. They may cover those that make more as well, and often cover people with higher income levels if they are minors, are pregnant, infants, and others, and are required to cover children under 6 and pregnant women who make 133% of the poverty level or below. Children in foster care and some children who are adopted also receive Medicaid. Most states go beyond these federal mandates and choose to cover a much wider group of people.
The idea that all people who do not have insurance are too poor to afford it is not entirely true. Those that are too poor to afford insurance are covered by a state program, in the same way that people that are too poor to afford food are covered by programs to assist in that matter.
There may be some who have fallen on hard times and have bills to pay, but the idea of “repossessing” medical care will remain in science fiction movies and has not been a way of life for the American people, and people have bills of all sorts, not just those that are medical. The idea that someone is too poor to afford medical care, either in insurance form or with actual doctors, is more of a matter of personal opinion, as most who are actually poor are already covered with a government program.
This is where the issue comes in. I had a friend with two children and a mother who was ill. She took care of all of them - alone. They all went without health insurance for several years, even though the mother was very ill and had been in a serious accident leaving her with brain damage. With all that, high blood pressure and some other serious problems, the mother was denied medicare. The friend, who was taking care of her family made just enough so that they couldn't get medical help but she didn't qualify at work. When her son had to have emergency knee surgery, they finally gave her CHIP for her kids and gave her mother PCN which is a very, very, very scaled down version of Medicare - totally bare bones. Basically, it helped with her prescriptions.
At any rate, people think that the poor and the elderly are all insured and taken care of. That is not true. It is a fact that over 50% are, but it is also a fact that those who make even $10 too much are often denied care even if their doctor pleads for it.
Hopefully everyone from the president down on the left or the right will leave politics out of the heathcare issue and make sure everyone who needs it is taken care of with the new legislation.
June 23rd, 2009
There are a lot of opinions regarding the medicare discussion, and that is fine. With individuals who have insurance through work or others who have various types of insurance coverage, they aren't as riled up about the situation. On the other hand, people who have Medicare and benefit from it are happy to have it. Here is a story sent in to a newspaper from someone who has and is happy with Medicare. As a 67 year old, I've had Medicare three years. It's great. $96 per month premium (all oldies pay that regardless of a private plan anyway), very modest co-pays for office calls, choice of doctors anywhere anytime and other similar benefits. Medicare is a (public option) single payer system. The VA is socialized medicine and I see no problem with either in the real world. How many people do you hear wanting to give up their Medicare, VA medical care, or even Social Security? Curmudgeons and Knowthings arise! If, in the proposed reform (in Congress this week), people wish to continue on a private plan (with 20-50% markup for profit) let them do that, and, BTW, that's why the insurance industry is fighting to keep their cash cows and DENY (like they do claims) a public option! Notice that they don't want the so called "free enterprise" system to work because they know they can't compete with a public option with a 2-4% mark up. France's healthcare is a mixture of private with a public option. I've lived there and it seems to work very very well. I also have no problems with any post office, fire/police department, DMV, and other public entities. What if city water, police and fire departments were private, as is current "health" insurance? I urge everyone interested in a real choice for a public option with NO "TRIGGER" call and email Senator Klobuchar and Congressman Collin Peterson every day this week to give them the push off the 'timid' fence to make a genuine entry into the 21st century.... the U.S. is one of the last to offer public health insurance to people under 65! Taiwan copied our Medicare system as their public health insurance option! Carole Adelsman Dalton- Published Tuesday, June 16, 2009 - Fergus Falls Daily Journal
June 16th, 2009
This is a question that keeps going back and forth between all of the individuals who are working hard to come to a solution to the healthcare and Medicare woes. Each side of the issue feels strongly about their position.
One side says that Medicare needs to be done away with or completely changed. They feel it has too many flaws and issues, as well as financial deficits, so that we might as wel start from the beginning and build something new.
The other side feels that the foundation of Medicare is perfectly fine and started out differently than it is being used now. Still, the foundation could still be used now with a few changes to make it work better.
From a lot of articles I have read, though there are flaws in Medicare and the need to be adjusted, as most or at least half of the the individuals involved in the debate agree, the foundation is solid, and after all, it has worked for several decades.
Part of the issue, of course, is that the beginning, there were a lot fewer Medicare recipients at that time. In addition, the costs of medical care were far lower than they are today. So lawmakers have been working on both ends of the issues - trying to get healthcare costs under control while at the same time, trying to make sure that Medicare recipients get their needs met to the extent possible.
This can be a model for healthcare reform from the standpoint because if the foundation for Medicare is used to build upon to reform healthcare, it could eliminate some or most of the flaws as well as making medical care available for all.
Time will tell how all the situation works out for both Medicare and Helthcare reform. Hopefully the reforms will result in at least basic medical care for all, which is something that is sorely needed in this country.
June 16th, 2009
It's no secret that Medicare has problems to be fixed. However, the issue regarding oxygen support for patients on Medicar who need that type of treatment to basically stay alive is confusing Medicare recipients. The gist of the proposal by President Obama and his team working on Medicare and Healthcare reform is that first of all, patients will continue receiving their oxygen. This is an important point, since the way it sounds as lawmakers are hashing ths out is that patients coule lose their oxygen care. This should not happen. It is an issue to be hashed out with oxygen providers and not patients. What is actually proposed is that from the time that individuals on Medicare begin oxygen, suppliers and providers will provide it at their regular prices for the first three yeas that it is being provided. Once the three years are up, the providers will continue providing oxygen services at a lower price for two years and then they will go back up to their regular price, or if there is enough money by then, they may receive a slightly higer price because they hung in there and kept providing services at the lower price for those two years. This is the part where it gets sticky because, as you can imagine, suppliers and providers aren't too happy about getting a dock in pay. As part of the Medicare reform, the President and lawmakers are trying to figure out this part of the deal for oxygen suppliers. They are trying to make it affordable for suppiers and providers to be able to continue suppling oxygen to their customers. After those two years at a decreased amount in pay to the providers and suppliers, the price, as we mentioned above, will go back up to the prevailing price or possibly a little higher, as a sort of bonus for the sacrifice made during those two years. The important thing about all of this is that Medicar recipients who rely on oxygen services will continue receiving them. Most oxygen service companies do not just serve Medicare recipients meaning that they have income from other sources, plus they get to know their Medicare clients over the years, so most of them will continue to help them because we are all human trying to help one another. The President and lawmakers are trying to take the money they have for Medicare services and, instead of making huge cuts in one area, they are trying to make smaller cuts in several areas so that providers including oxygen suppliers, home health care, doctors, nurses, technicians, hospitals and more, can continue to provide services. They are trying to find a way to make it affordable to the healthcare providers without taking those services away from Medicare recipients that depend on them. As for oxygen services, if you are on Medicare and receive oxygen services, they will remain uninterrupted. Three years down the road, you may have to switch providers if your provider is not willing to take a cut in pay, however, you will still have services - just from another company. Also, since the President and lawmakers are still working on this, it may actually turn out better than some people think. After all, if I provide you services at a good price for three years, then take a cut in pay for two years knowing that after that, I will be providing for you at a higher price after those two years and there will be no more cuts, I am not going anyplace because I have a loyal, long term client that I may be serving for 10 or 20 years. When I look at it that way, what's two years at a lower pay? So, those of you on Medicare using oxygen services, don't start worrying. The government is trying to figure out a fair way to keep your services going. You will not have to give up your oxygen. Your provider may have to be willing to be more flexible during those two years if possible, or you will get a new provider. So try not to worry and just breathe a little easier.
June 16th, 2009
Medicare has evolved into a program rather different now than when it started. It covers over 40 million seniors and it has changed the way it is administrated. In addition, poor oversight has caused cutbacks and tight budgets which means that there are cutbacks in services, cutbacks in payments to doctors, hospitals and other medical professionals.
Yet, Medicare still moves on. They have been predicting its demise for years but it is still here. Now, don't get me wrong. It is obvious that Medicare has some serious financial issues. It is also possible that in the years between now and the time the program is supposed to run out of money, there are many things that can be done to straighten out the program by creating better oversight regarding fraud and abuse, creating better incentives for doctors in the program to stay - especially some of the great doctors that are treating Medicare patients at a fracthion of the price that they treat their private patients. This is a sacrifice financially because they care about their Medicare patients.
I have talked to doctors and other healthcare professionals who treat Medicare patients. Some of these have a patient load of 50% Medicare patients. I know of a few that treat nearly all Medicare patients because they have no place else to go. The majority of doctors say they can't afford to take on any new Medicare patients. The sad part of the situation is that with the right "tweaks" many doctors could take a few Medicare patients each. If a doctor is taking home $250,000 per year and took 10% Medicare patients, it wouldn't make him or her go broke, it would bring in extra money and it would help elderly people who need medical care. If he Medicare system could help devise a way where doctors got something out of treating Medicare patients and send out information about this to every doctor in the country, more doctors would be able to take a few Medicare patients and more elderly would be receiving continuous treatment. This would save money for the system because even if these doctors who took 10% of their caseload as Medicare patients and received a small bonus or other perk for doing so, the majority of patients would stay healthier longer and avoid costly trips to the emergency room or costly stays in the hospital or long term care. Medicare pays for these. If a doctor could help Medicare patients stay healthier and out of the hospital, perhaps he/she could receive a bonus which could come from a small percentage of what was saved for Medicare by keeping the patient healthy and at home. So the doctor gets $1,000 and Medicare saves $10,000 to $50,000. That sounds like smart finance and a win-win situation for everyone.
The elderly depend on Medicare. Some still have the means for private insurance, but even so, their Medcare benefits help defray other costs. There are ways to make sure that doctors can afford to treat Medicare patients and make enough money for it to work while at the same time actually saving Medicare money.
I am not privvy to the information being discussed in the battle over Medicare, Social Security and Healthcare by lawmakers on the hill in D.C. I just know that if I can think up something this basic, the leaders who are far more savvy than I am should be able to come up with a solution to keeping our elderly covered by Medicare and our doctors willing to take Medicare patients. There is enough time for these intelligent thinkers to come up with a plan that will work for everyone. This is not a maybe. This is a moral imperative.
June 11th, 2009
It's no secret that Medicare has some problems and flaws, and it's no secret that some pundits and lawmakers would like to just toss it in the trash and start over - or not. The unfortunate part about eliminating Medicare is the millions of seniors it would affect - seniors who depend upon Medicare to survive - literlly.
Many seniors live on Social Security and bring in well under $1,000 per month to pay all their bills including their rent. They can barely afford to keep the lights on and food on their table, and the only way for them to get medical care is through Medicare. Even with its flaws, Medicare helps millions of the most vulnerable among us. What would you do if you had diabetes, were 70 years old and had no place to go for treatment and no way to get medication that basically would keep you alive? What about if this was your parent and you didn't have the money to help because you lost your job, your savings and your retirement in the recent downturn in the economy? That's a pretty difficult question to ponder because in many situations we are talking about life and death.
Then there is the next group in their 40's or 50's where Medicare will be critical to them soon - especially if they already have high blood pressure, diabetes, heart problems or other serious issues. What will they do if lawmakers eliminate Medicare? What if they don't have the money to get care for their medical conditions. I have a mother who helped people get assistance for many years and it was gruesome. It isn't getting more fun as the financial and other problems have gotten worse.
I have read many theories on what to do with Medicare. The most of them made good points on cutting out fraud and waste and changing the system so that those that do certain things to both treat their patients well and keep costs down (it is possible) receive bonuses, while those who don't measure up not only don't receive bonuses but get deductions in pay. If they really don't measure up, they can be investigated and possibly eliminated from being able to be a provider in the Medicare system.
As for fraud and waste, these issues have been handled internally like the fox guarding the hen house, for many years. It is time for an outide independent entity to keep track of checks and balances and make sure they are real. If a medical supply company or doctor's office or hospital orders a certain amount of a particular product or suppy, there should be an outside middleman making sure that what's ordered is received and is paid for to the penny. Just eliminating this kind of fraud will save Medicare according to the CMS at least one billion dollars per year. Think of how many services that would provide.
There wil be no easy fixes, but there are fixes and if the best and brightest lawmakers unite, regardless of party or who likes who, Medicare can not only be fixed - and this may take some time and a lot of work - but the foundation is good, the model is right and Medicare can be fixed before the money runs out, leaving enough for our children and grandchildren rather than leaving them nothing.
June 11th, 2009
There are citizens and lawmakers on many sides of the Medicare debate. For many citizens, Medicare works for them, they depend upon it and it keeps their health and healthcare stable. For others, it doesn't work as well, but it still works for the most part. The big problem as far as the lawmakers seems to be juggling money with care. Unfortunately for too many years there were pet projects coming out of the Social Security and Medicare Pot of money until here we are. That doesn't mean we need to destroy a system that can work if managed correcty to make up for financial mistakes of the past. The best way I have heard it put in a while is in the blog below:
Medicare works, despite flaws
First published in print: Tuesday, May 26, 2009
Your concern for the single-payer health care option is well founded (editorial, May 19.) Instead of embracing change, the vast and entrenched health care industry, like the auto industry, fights it and to its own detriment.
But there is another critical dimension of this struggle that your editorial doesn't address. That is the three-ring circus some refer to as the legislative process.
If there was a genuine interest in fundamentally changing the delivery of health care in this country, the lowering (in five-year increments) of Medicare eligibility is rational, reasonable and modest. Everyone would be covered eventually with graduated increases in Medicare taxes.
Industry interests could hardly claim that Medicare is radical or creeping socialism. It is more than 40 years old and a widely embraced government service, albeit not without flaws.
However, it is endemic to the legislative process that good and simple ideas must first be purged and percolate while a certain extraction process unfolds. This process is not to be confused with extortion, to which it is closely related.
Despite the merits, Medicare expansion must be thrown into a hopper of any number of special interests schemes and proposals, and allowed to stew while legislators fulminate and patronize to prolong discussion and pretend interest to all.
Why? To extract as much as possible in the way of industry campaign contributions.
As a staff person in the state Legislature, I foolishly advised support of the bottle bill when it was first introduced because it made eminent sense. I was not then aware of the extraction process.
Single-payer health care is too important an issue to suffer this legislative phenomenon.
Michael J. Cummings
Albany
Perhaps if lawmakers keep looking closely - like when we are trying to find a way to use the last "Q" or "Z" in Scrabble - they will come up with an answer that works for everyone.
May 27th, 2009
It is estimated that the number of internists will decline substantially by 2025, and the Medicare Payment Advisory Commission indicates finding a new primary physician is becoming more difficult for seniors—meaning that Medicare recipients should begin as early as possible for the best doctor and get established and comfortable with that doctor.
According to MedicareSupplementPlans.com: Many Medicare recipients, are having a difficult time finding a new primary care physician. A 2008 survey conducted by the Medicare Payment Advisory Commission (MedPAC) found that by 2025 there will not be enough primary care physicians. In addition, an estimate from the American College of Physicians (ACP) that there won’t be enough internists to go around by 2025. Let's add one more issue: the ACP also indicates that current internists are becoming less willing to accept new Medicare patients.
According to Alan Weinstock, an insurance agent at MedicareSupplementPlans.com, many physicians are no longer taking Medicare because reimbursement rates and too much paperwork. With all these trends converging at once, Weinstock believes Medicare recipients need to shop early to find the best doctor—before they turn 65. "It’s traumatic turning 65 and entering an unknown area of new healthcare. So many questions…wondering if you asked the correct ones and were given all the correct facts."
“The impact on seniors of physicians opting out of the Medicare program hasn’t been a serious problem yet,” said Weinstock. “But if large numbers of physicians join the group that is opting out, it may be difficult for seniors to have access to affordable health care.”
This is why it is important for the 40 million Americans who have Medicare insurance or those who will be starting Medicare soon to start early in their hunt for a physician who still accepts Medicare. Many of the physicians who accept Medicare now may not accept new Medicare patients but will still continue to take Medicare as payment for the patients they already have if a good relationship is established. It is equally important that seniors take the time to determine the best Medicare supplement insurance coverage, since Medicare often does not cover all health care costs.
Robert Dowell of Visalia, Calif., understands full well the need to have someone knowledgeable when searching for the best Medicare supplement plan. “It’s traumatic turning 65 and entering an unknown area of new healthcare. So many questions…wondering if you asked the correct ones and were given all the correct facts.” But Dowell found all the answers he needed at MedicareSupplementPlans.com and says that now he “has a clear path on how to control my health needs.”
If you are a Medicare recipient now or will be soon, check with your doctor or a recommended doctor and check with the references in this article so that you will be prepared with a doctor who will accept Medicare benefits as payment for your treatment.
May 27th, 2009
This seems to be a week for special stories that need to be told and need to be heard. There are many stories about problems with Medicare, just as there have been many successes with Medicare, as well. The fact that Medicare is in trouble in various ways is not news. We have been hearing this for decades, yet, it has taken until now - where Medicare is in a crisis - for lawmakers to sit down and really pull up their sleeves and put in the work to try to stabilize not only Medicare, but Social Security and the entire healthcare system.
It doesn't matter who is to blame or how many presidents back contibuted to the mess rather than fix it. For years it has been known that if a pet project needs funding all congress has to do is tap into Medicare or Social Security funds. Lawmakers know it and the public knows it. Just the charges alone for a pill or a pillow show that there should be more control over the system and more regulations between Medicare and the pharmaceutical companies as well as other vendors. Now we are all dealing with the results.
Below is a story I read that shows the results of a system that has been poorly managed - and, at times, not managed at all. I am leaving the story as written, as it speaks for itself. This is why we have to fix the system. There is no alternative.
My Medicare Experience
by jboettner
05/19/2009 01:02:14 PM EST
My father passed away last July 2008. Even though he is gone, I thought people should know about a couple major issues we encountered with Medicare.
First of all, my father was in rehab recovering first from hip replacement surgery, then from revision surgery. When Dad was a few weeks from discharge, he fell down and broke the same injured leg, and extended his recovery time indefinitely.
The problem is under Medicare patients only have 100 days to utilize rehab facilities, once 100 days were exhausted, my father's care immediately jumped to $200/day.
In addition, I found a source of VA medical supplies from a friend who died; we thought we'd ease the burden on Medicare with the second hand supplies.
I was very impressed with the quality of the VA equipment. But Dad's nurse determined that he needed a special pillow for his wheelchair, and the only way he could get the special pillow was to get a Medicare supplied wheelchair. As we found the Medicare wheelchair was not only inferior to the VA wheelchair, but as far as the "special pillow," about the only thing special was the $500 cost!
As we get ready to launch this major effort to reform healthcare, I just thought you should be aware that private industry seems to have also co-opted Medicare.
Apparently there is a 60 day period between medical events required to qualify for another 100 day rehab period. This would have been nice to know, but even if we did I doubt the outcome would've been different.
When we can approve $500 for a pillow when the patient can get it for free, plus deny a free wheelchair from the VA - in better shape and better quality than the one being provided by the facility through Medicare and forced on the patient - this shows why Medicare is in the mess it is in. This hapens thousands of times over. It is time for it to stop
May 19th, 2009
When you have one pot of money and it is finite, it can be hard to split it up in a way that makes everyone happy. Let's take what the government is going through with the budget right now. It would be great if they had unlimited amounts of money, if the automakers and banks weren't in big trouble and if Medicare/Medicaid and Social Security were at least stable.
But the picture isn't that pretty, and the fact that we are in the middle of a recession doesn't help either. Add to that bad mortgages, foreclosures all over the place and handing over money to the banks without an accounting of where it has gone and the picture gets worse.
As to the banks supposedly showing profits recently from the bailouts, take a look at Dr. Martin Weiss’ article, Big bank profits are bogus! Massive public deception! He writes, “Was the bad-debt disease magically cured? Did the economy miraculously turn around? Not quite. In fact, we have overwhelming evidence that the condition of the nation’s banks has deteriorated massively since then.
“How can our trusted authorities be so blatantly deceptive and still keep their jobs? Perhaps you should ask Fed Chairman Ben Bernanke. Not long ago, for example, he declared that the total losses from the debt crisis would not exceed $100 billion, while conveying the hope that most of those losses could be soon written off. Also around that time, the International Monetary Fund (IMF) estimated the losses would be $1 trillion, with only a small percentage written off. The IMF’s latest estimate: $4 trillion in losses, with only one-third of those written off so far. Bernanke’s error factor: He was 4,000 percent off the mark, in a world where 50 percent errors can be lethal.”
And the critics talk of Medicare’s $1 trillion in costs last year to cover 42.5 million seniors. This cost was inflated by the privatized HMOs, PPOs inserted into Medicare along with the rule that Medicare could not bargain with Big Pharma on drug pricing as does Medicaid. These are a few of the negative impacts inflicted on Medicare by the Bush administration and others. In fact, Medicare began in 1964 under Lyndon Johnson as a classic single-payer health insurer. Listen closely, President Obama. It was only later that the privateers were ushered in to gobble up 12.6 percent of its premium revenue for “administration.” What if Medicare got some of that bank bailout money?
Yet the Times reports, “as a result, the administration said, the Medicare fund that pays hospital bills for older Americans is expected to run out of money in 2017, two years sooner than projected last year. The Social Security trust fund will be exhausted in 2037, four years earlier than predicted, it said.” The question is to whom will that money run out to?
Though there are many priorities here, this is a country that touts taking care of the neediest among us first. "Give me your poor...your huddled masses..." The country was founded on these ideas. All of the rest of this stuff we are dealing with now came later and some of it did not have to come at all.
The new president has said that this is our time, this is the time for change. It seems that he and lawmakers are trying to figure out what to change first and how to do it so that everyone comes out at least somewhat stable. I wouldn't want to be in their position - the president and lawmakers were left with quite a mess to clean up and figure out and it hit them all at once. It doesn't matter who is or was to blame. The blame game can go back decades and waste time that we don't have. It is time to fix things once and for all, and it is time for everyone to stop whining and get the job done.
May 19th, 2009
The New York Times, Washington Post, and Wall Street Journal's world-wide newsbox all had lead articles with regard to a new government report that paints a dire picture of the financial situation of the nation's two largest benefit programs. The recession, of course, has not helped with the already stressed Medicare system, especially the fund for hospital care which will run out of money (purportedly, depending upon who you get your information from) in 2017, two years earlier than the government had predicted a year ago.
The Social Security trust fund is in a bit better shape but will still start spending more money than it receives in 2016 and will be depleted by 2037, four years sooner than projected last year. lawmakers are arguing over whether the country can really afford to expand health insurance coverage, the report sparked calls for the administration to start working on a plan to prevent the two entitlement programs from becoming insolvent.
There is a great deal of work going into the Medicare situation as well as trying to create a similar healthcare system for everyone who does not have health insurance or access to health insurance, to strengthen the Medicare system that definitely needs bolstering and create a health care system that millions of people need.
Lawmakers feel that tax dollars from workers, such as payroll tax, deductions for social security and other funds will be able to help finance all of these ideas. In addition there are some Lawmakers pushing hard to stop subsidizing and just flat-out give banks and othe institutions "bailout money" why not give out less or none at all , for that matter, to fund more of the domestic issues especially. Another idea has been to patner the banks with the insurance companies and help them work together to develop a policy that would be fiscally responsible. If the polcy worked out well, it could very possibly help bolster Medicare and the the vast majority - if not all - of the people in the country that are uninsured.
May 14th, 2009
"The New York Times, Washington Post, and Wall Street Journal's world-wide newsbox all had lead articles with regard to a new government report that paints a dire picture of the financial situation of the nation's two largest benefit programs."" The recession, of course, has not helped with the already stressed Medicare system, especially the fund for hospital care which will run out of money (purportedly, depending upon who you get your information from) in 2017, two years earlier than the government had predicted a year ago.
"The Social Security trust fund is in a little better shape than that, but will still start spending more money than it receives in 2016 and will be depleted by 2037, four years sooner than projected last year.
Lawmakers are arguing over whether the country can really afford to expand health insurance coverage, the report sparked calls for the administration to start working on a plan to prevent the two entitlement programs from becoming insolvent. "
There is a great deal of work going into the Medicare situation as well as trying to create a similar healthcare system for everyone who does not have health insurance or access to health insurance, to strengthen the Medicare system that definitely needs bolstering and create a health care system that millions of people need.
Lawmakers feel that tax dollars from workers, such as payroll tax, deductions for social security and other funds will be able to help finance all of these ideas. In addition there are some Lawmakers pushing hard to stop subsidizing and just flat-out give banks and othe institutions "bailout money" why not give out less or none at all , for that matter, to fund more of the domestic issues especially. Another idea has been to patner the banks with thr insurance companie help them work togethe develop a polcy that would be fiscally responsible. If the polcy worked out well, it could very possibly help bolster Medicare and the the vast majority - if not all - of the people in the country that are uninsured.
There are many other ideas floating around and some are being very seriously lookde at by Lawmakers and the administration, especially when it comes to where revenue from taxes that already exist could be found and used. As the president said in the beginning, this is not going to be easy but we will figure out a way to get through it.
May 13th, 2009
With the healthcare system -including Medicare - being as out of kilter as it is, there have been many suggestions as to how to make it work more efficiently and turn it into a system that can last and help many more people for a long time.
Social Security and Medicare work beautifully for the majority of enrollees and they provide at least some security and medical care to millions of American families who would otherwise go without, especially now in hard economic times.
More and more people are asking President Obama to look into supporting a "single payer'' health plan, assuring universal health care in this country.
.
Usually, the single payer is a government agency that provides one-stop health coverage. In contrast, the American system of paying for health care has been called a chaotic maze of health providers, private insurance plans with wide variations in coverage, deductibles, co-pays, and a confusing and frustrating situation for the individuals who need the coverage and are trying to figure it out.
Many lawmakers are saying that an effective way for the U.S. to move toward a single payer plan would be to expand Medicare to everyone. The smart idea in this is that it would not be free. If you are working, some of your taxes could pay for the premium, and there are other ways to offset the expenses.
At present, the White House stated that a single payer system was not acceptable to the Obama administration.at this time
because the goal of the president's health care reform objective was "to cut costs for families that are watching their premiums and their co-payments and their deductibles skyrocket.''
Experts who have compared the various plans say a government-run single payer plan would be less expensive than private insurance. There would be less overhead and no marketing costs and no compulsion to rack up profits.
There are some 47 million people without health insurance -- and thousands more are losing their health benefits with their jobs.
There are a number of proposals being presented in Congress that would provide health insurance coverage for every person in the United States. They would provide all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, as well as dental, mental health, physical therapy, hearing and vision aids and long term care. And though each one is a little different in the details, 6 or 7 of these proposals are for single payer plan.
May 7th, 2009
The current administration is trying to create big changes in Medicare as they try to overhaul and reform the healthcare system. This could mean something quite new for seniors and may be a template for reforming healthcare in this country in general.
The idea is to create less waste in the entire healthcare system and strengthen Medicare, as well as covering the uninsured.
Medicare covers about 45 million Americans who are elderly or disabled, and its policies are followed by many private insurance companies when they set up their internal systems. The new approach and ideas for seniors would helMedicare p medical professionals stress and help patients with follow-up care by their family doctors and nurses so that more chronically ill patients could avoid being hospitalized and re-hospitalized when chronic problems such as high blood pressure get out of control.
There would be changes for doctors and hospitals, too. Primary care doctors who care for patients on a more constant basis would be paid more, while specialists would be watched more closely, especially as they order more tests and procedures. Hospitals could have to pay penalties if they did not provide adequate follow-up care, therefore having the same patients continually being readmitted for the same problem.
Medicaid would also see similar changes, which would affect most of the 50 million low income people that they cover.
“Medicare is going to be the driver to achieve quality reforms, in large part because the other players tend to follow Medicare,” said Sen. Max Baucus, D-Mont., the Finance Committee chairman. Baucus aims to have a bill on the Senate floor this summer that would restrain costs and cover the estimated 50 million uninsured.
The committee meetings that are slated will iron the details out, and some of the meetings have already started. This effort is aimed at helping even out who pays for these benefits and how. The sickest 10% of the patients account for nearly 2/3 the cost that Medicare spends per year. These are frail individuals who usually have more than one serious chronic condition such as high blood pressure, diabetes and heart disease. The cost is so high because they are seeing several specialists for each issue. If the changes that are being examined can be put into place, they could be seeing one doctor who could control and coordinate the other treatment they receive, eliminating duplicate procedures and eliminating waste.
If and when lawmakers are able to straighten the health care fragmentation out, it is very possible that everyone could get good care and save money at the same time.
April 28th, 2009
The current administration inherited a lot of problems, not the least of which is the healthcare issue – both Medicare/Medicaid and private health care plans. Trying to balance all these out is difficult at best and, though people are looking at the “first 100 days”, 3 months is not actually a lot of time to deal with these issues on top of the other national and international issues this country faces, not to mention that even Superman and all his super-hero friends could not come up with a plan to solve all these problems in 3 months – period.
However, Obama and lawmakers are trying to iron things out. Healthcare is extremely critical because of the number of families without it and the number of seniors who depend upon it.
There have been many ideas explored to try to solve the problems inherent in the system at this point, but no solutions yet. One of the ideas on the table is something called entitlement reform, which means that Social Security and Medicare/Medicaid would be rationed (no examples given yet) and supposedly save the system, the government and the taxpayers trillions of dollars, partially by eliminating or rationing services – including education and prevention programs to keep people from getting worse and having to use the system in the first place.
Proponents of this entitlement reform in the form of rationing, feel that this would then balance the budget because of the trillions of dollars saved. They blame President Obama for not offering this type of reform, but instead trying to initiate universal health options so that everyone in this country would be able to have at least some sort of health care – even if it was very basic.
They seem to forget that Obama did not create the problem; he inherited it and is simply trying to fix it somehow with the help of Congress. Lawmakers are working on adjustments to try to make all of this work, however this will take time. As promised, the president and lawmakers hit the ground running minutes after inauguration. Is it possible that the pundits who say that the only answer to the healthcare issues is rationing can just give the actual lawmakers enough time to work on this mess – that has taken decades, especially the last 8 years – to get to this point? It’s like gaining 50 pounds in 5 years and expecting to lose it in 3 weeks. It is impossible for that to happen. It took time to get to that point. It will take some time to get fixed.
A quote from Charles Krauthammer of the Washington Post, a proponent of rationing sums it up this way:
.
“It is estimated that a third to a half of one’s lifetime health costs are consumed in the last six months of life. Accordingly, Britain’s National Health Service can deny treatments it deems not cost-effective —- and if you’re old and infirm, the cost-effectiveness of treating you plummets. In Canada, they ration by queuing. You can wait forever for so-called elective procedures like hip replacements.
Rationing is not as alien to America as we think. We already ration kidneys and hearts for transplant according to survivability criteria as well as by queuing. A nationalized health insurance system would ration everything from MRIs to intensive care by a myriad of similar criteria.
Social Security was the third rail of American politics. Not anymore. Health care rationing has ascended —- which is why Obama, the consummate politician, knows to offer the candy (universality) today before serving the spinach (rationing) tomorrow. It will work for a while, but there is no escaping rationing. In the end, the spinach must be served.”
Charles Krauthammer may be right in the end, however, exploring other avenues that could possible help more people in a broader way and bring in premiums to offset costs might not be a horrible answer, either.
We will all have to see what happens as things get hammered out, and when they do, if Charles is right, I’ll be eating my spinach right along with everybody else.
April 28th, 2009
The cost to Medicare for managing chronic kidney disease (CKD) is high; however, IPRO is urging health care providers in New York to work together to both improve patient care and reduce costly complications from the disease.
Medicare costs for CKD and end-stage renal disease (ESRD) exceed $70 billion annually according to United States Renal Data System (USRDS) data. IPRO is one of only eleven organizations from across the country that has been chosen by the Centers for Medicare & Medicaid Services (CMS) to work on a new pilot project that has the potential to both help patients and save taxpayers a substantial amount of money.
"We are partnering with primary care physicians, nephrologists and vascular surgeons to improve care for patients at risk of, and with CKD by preventing or slowing the progression of the disease," explained Clare Bradley, MD, MPH, Chief Medical Officer at IPRO. According to the USRDS, the savings to Medicare for each patient who does not progress to dialysis is estimated to be $288,000.
Bradley said improving the health and well-being of CKD patients could have a substantial economic impact considering Medicare beneficiaries with CKD account for 16.5 percent of Medicare costs in the year the disease is diagnosed, and 11.1 percent in the next year.
"We are confident that better care for these patients can lead to considerable cost savings, improved outcomes and better quality of life because it can mean less reliance on drugs, dialysis, and hospitalization," said Bradley. The IPRO project encourages prevention and early detection of CKD and proper medication recommendations to slow the progression of the disease.
IPRO also supports the nationwide Fistula First effort which addresses the need for patients who suffer from ESRD to have safer, higher-quality access to hemodialysis through a fistula. Bradley explained that a fistula is a "connection" surgically created by joining a vein and an artery in the forearm allowing blood from the artery to flow into the vein for safe and easy access for dialysis.
"Fistulas make a real, proven difference in the health of the patient. By providing a method of dialysis that is safer, longer lasting, and less likely to cause infection, fistulas are seen as the gold standard for vascular access," said Bradley.
Fistulas reduce serious infections and complications leading to hospitalizations and mortality often associated with other forms of vascular access for kidney patients. Vascular access complications account for 16 to 25 percent of all hemodialysis patient admissions, contributing to about $1.5 billion in Medicare costs annually. In addition, fistulas cost less to maintain than other forms of access and are associated with less re-work and complications requiring hospitalization.
IPRO is part of the nationwide Quality Improvement Organization (QIO) Program. QIOs work with health care providers, consumers and stakeholder groups to refine care delivery systems to make sure all people - particularly those from underserved populations - get the right care every time.
This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy.
This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy.
April 15th, 2009
A lot of people think that Medicare and Medicaid are the same thing. They are however, not the same, not even close. Yet both in our minds and in the news media, Medicare and Medicaid are always lumped together.
On July 30, 1965, President Lyndon Johnson signed both Medicare and Medicaid into law as part of Title XIX, The Social Security Act. Both are related to healthcare. Both have substantial Federal involvement. There are some individuals who are eligible for both. That is where similarities end.
Medicare
Before 1965, only those who were in the workforce could get employer-subsidized health insurance. Thus, the retired (and the non-working) were effectively prevented from acquiring medical insurance coverage. The Medicare Program was planned, like social security, as a pay-in-advance-of-need system where the worker paid a certain amount each month into a government-run fund. At age 65, when the worker retired, this pot of money called Medicare would provide all his or her medical coverage funding. Initially, the Medicare Fund was maintained and accounted separately but quickly the Federal government lumped it into the General Fund.
Twenty-five years later (1990), the GAO measured how much Medicare was actually costing versus what was projected. Medicare then cost more than 800% over projections! This was a medical insurance plan whic intended to pay for itself but instead had become a Federal entitlement that was never intended.
Medicaid
Medicaid was always intended as an entitlement - a social welfare and protection plan funded jointly by State and Federal government funding. Initially, the Program covered low-income and non-working people, children and indigent people.
Medicaid as specific qualifications. To qualify, you must make less than a minimum income level, plus you must meet one of the categorical requirements such as age, pregnancy, disability, blindness, HIV, legal citizenship, etc. In contrast to Medicare, Medicaid recipients pay nothing into any fund. It always was and is an entitlement.
Beware when we tout single payer health insurance funded by the government as a means to provide universal health care that will reduce costs. The upward spiral of healthcare costs will reach the stratosphere - the truly unsupportable - for two reasons. 1) As entitlements expand, costs go UP certainly not down. 2) The government is a notoriously inefficient provider of, well, anything. When Government takes over an activity, the bureaucracy and its associated costs expand exponentially. Just think of the postal service or HIPAA. If you need additional proof of how costly government-run programs are, just remember the initial estimate for cost of Medicare and compare to the reality.
As time has progressed, there has been more attention given to Medicare and Medicaid. The current lawmakers are making some cutbacks wile at the same time trying to make both of these work. We will see what happens in the near future as some of the legislation that is being worked on is rolled out. In the meantime, at least there is an attempt to bring both programs forward into te 21st century.
April 15th, 2009
Previous Posts
