Officially Old

As of the first of the Month, I am now "old". That is old as I used to view it.
I received my Medicare Card. Hoorah!

My spouse and I didn't believe we would see this day. We figured Social Security would be gone by the time we hit this age. OK. We didn't really care we were helping to pay for our parents and for a short time for a grandparent or two.


But here we are.
The feeling is of freedom.

The painful forms I was expecting at the Doctor's office didn't appear. But this time I could talk to him about drug choices without worrying about the employee drug plan telling us I could not get the drug that is better unless I paid for it myself as well as their premiums. This time I could pay my part of the visit right then instead of waiting for the insurance company to drag it out and negotiate "for me". (and by the way my part is cheaper under Medicare) I feel better about that I hated for him to give me and the insurance company interest free loans every time I saw him. Yes I still have a deductible but it is not $2500 per person. Yes we are having premiums withheld from SS but nothing like what we were paying even through the company plans. The drug plan, that could tell me I had to use a step program as the drug I had taken for 2 or 3 years was not on this company's formulary; the drug plan, that got a better deal a little later so informed the spouse that they recommended that he go on the drug I was on in the first place, is gone.

Sometimes they made me feel as though I just wasn't trying hard enough to take care of myself. Well, of course, I can do better but most of the time I work hard at it.

Now as I pick my own Part D plan, not that hard. I can hunt and find one that will allow my Dr. to have more say so at the same time hunt for the best cost plan. A plan that will not just decide to turn him down really before he submits their paperwork with his reasons for giving me the non-generic form. He is the MD after all. He has lots of education and experience. I looked long and hard for good physician and paid extra high insurance premiums to see him. We can discuss cost vs. "return". I can take the one that he believes is better for me with my family background and my already somewhat blocked carotid artery

Premiums will definitely go up but the ability for my Doctor and I to work to find the best drug for my brain's sake is worth it. And since he is very familiar with Medicare he will know how to work with them too.

Now if I had my way for everyone in this U.S. of A. I would love to see somebody go back after the Drug Manufacturers. You remember those discussions about how they pay so much in R&D, NOT! (It is advertising. I wish they couldn't advertise on TV. Oops free speech?) And if I had my way, everyone would have health care as provided by good physicians and hospitals. And drugs would be reasonable. But I don't get my way and maybe this latest version of health care, "insurance", is it for now. It is better than no regulation. It will, I hope, keep the insurance companies from kicking us out for some piece of childhood information we forgot to put down on some form. Or some other so-called "pre-existing" condition. It will, I hope, keep the companies from raising our premiums by any amount they like anytime the like.

And Don't kid yourself that wonderful caring-about-us-old-folks-and-our-Medicare, which was in the main passed by Democrats, Republican party will do away with Medicare when it can. Or maybe the plan is just let it run out of money and it will be gone.

At least for now I am on that terrible government run, socialist, insurance and glad of it. So now I guess I am a cannibal eating my children and my grandchildren.

Health Care, The Status Quo Needs to Go.

Here is a personal story for you about health insurance coverage.
This is not one of those terrible stories but this is one of the more common ones that goes on everyday for people who have health insurance.

I must give you a little medical background first. My husband had an allergic reaction about 30 years ago. He is a frugal man and a person who tries to avoid hospitals at all costs. But after turning blue and other good things like that, he finally allowed someone to drive him to an emergency room-no ambulances for him either. Anyway he got there just in time. They gave him one of the “your heart is stopping shots”, you know, straight into the heart. Then he spent quite a while in ICU. So that is the early part of the tale. We never found out what caused it. He got the carry-these-pills-with-you-at-all times, take-one-and-call-an-ambulance-if-it-happens-again sermons as he was leaving. He did keep the pills with him for quite a while.

One evening recently he woke up with itching and burning, spreading fast, huge blisters forming etc. The pills would be no good after 30 years even if we did still have them. So, we go to emergency. You know this only happens when the Dr.'s office is closed. He got treated in short order. This time we were quicker the heavy doses of medicines worked and he didn't have to stay. Given another set of don't-take-a chance instructions again, we left. Things are fine thus far and we feel getting there more quickly this time saved a lot of fun for him and money too. We also are pretty sure this was a true emergency so that argument shouldn't come up.

So now last week we got the usual notices from the insurance company, Cigna, that they had received the bills and guess what-not paying one red cent. We have high deductible, $5000 family, but family does not include our son because he is 24 even though he is back in school full time, so family in our case is 2. We have high-patient-pays-about-everything-all-the-time deductible, but-we-will-negotiate- for-you insurance. Kind aren't they. The more they can negotiate for me the lower the chances I will ever see the $2500 deductible. Duh.

So I just sent the med center over $800 and the Dr's part will be over $300 when that bill comes. (I do not begrudge our med clinic, a good one, nor the ER Dr. one cent.)

We are retired and not quite old enough for Medicare. We are not wealthy. But we feel we are in fair financial shape. Yes, we saved and we invested for 30 some odd years. But $1100 to $1200 is a tad more than pocket change to us. Guess what. Once we reach the $2500 per person deductible they will start to pay 80% maybe. We always figure we will just pay most of any medical bills, so what do you do? We are not terribly unhealthy so just figure we will pay it and lump it.

In a short time we will be Medicare people. Guess what else. My husband worked for a company that had retiree insurance, one big reason he stayed with them when he didn't want to do so and when they were trying to figure out how to get him out. He hung in there because we knew we needed the insurance. They called it then, “the golden handcuffs”. Now when I say retiree insurance I don't mean it is all paid for; we pay some, and the company pays some. We were informed, several years ago, that when we hit Medicare we will no longer have much coverage, just call it basically gone, from the company insurance. We will no longer have the opportunity to get the drug coverage, we will no longer have dental insurance. The company does not pay for dental they get us a good deal and we pay that ourselves. And on it goes. The options we have had through the last 5 years have slowly disappeared anyway.

We have been a thorn in the side for quite awhile anyway. We live in small, rural area, with a great county med clinic and a good doctor but we cost the insurance company more because we can't be forced into an HMO-too far away.

Now I want you to know my family and I are lucky, well maybe not just luck, but some is luck. We are lucky that our health is fair-to-middlin; we are lucky we have any insurance still. We know these things. We are better off than most of the people we know.

What started me thinking about all this? The Med. Clinic just called because they realized we had a large bill and wanted to know if we needed help or wanted to set up a payment plan. I thanked the lady and said no. I told her we didn't figure on much ever from insurance we just keep hanging on to the insurance for the big catastrophes. Well, the catastrophes that the insurance company won't drop us over. I told the nice lady that called that these things are partly why the insurance company can figure I will do what I can, in my little way, to get “HEALTH INSURANCE REFORM”.

Now that I told you this little story go to a PBS station find the Bill Moyer's Journal, kind of a rerun but needed, on why we need “health care reform”. It will definitely remind you of why as President Obama says, maintaining the status quo is not an option.

link to PBS is; here.

Washington Week in Review was just excellent this week also here is the link to that show. www.pbs.org/weta/washintonweek/ here

Health Care Plans

Health Care Plan, Health Care Reform, articles abound this week.
Reading the articles, the editorials, and the comments of the readers is a feat in itself.
This is really a topic of interest to a lot of people. Many doctors write articles, editorials, and comments. Many politicians have much to say. The President is on the trail, holding town hall meetings. So you know I couldn't resist my two cents. Below is a comment I sent to the NY Times.


I guess I am just stupid or naive.
Why are the costs for health care so high in the first place? I doubt it is all about technology. Why are we, the government, going through this insurance mess in the first place? Why not just get drug companies to get realistic, get hospitals to look at their vendors and their yen for profit, get doctors to set their charges realistically. Why not get the patients to be responsible.
We all know those with insurance pay for those without in many ways. We all know about really “frivolous lawsuits”. We all know drug manufacturers are charging US consumers much too much. (no it is not their research costs-it is their advertising costs) We all know the population is not healthy and expects a drug or a procedure to instantly fix our bad habits. We all know that many if not most hospitals have brought in business managers to get profits up. We all know the problems with population demographics changing-more retired than workers.
I am for health care for all but why are we so worried about insurance companies. They have been around for as long as I can remember and they will probably not disappear. They will find a way.
I worked for a hospital years ago as a secretary. I remember my shock at what a little restaurant packet of ketchup cost then. We have all read or heard tales of the cost of a band aid in a hospital. We all are aware of errors in diagnosis or treatment do happen leaving some with a lifetime of pain or suffering or the inability to earn a living. Even worse we all are aware of , God forbid, deaths from these mistakes.
I see what insurance companies do “for me” when they negotiate for a visit to my doctor. My doctor in essence gives the insurance company a loan for months sometimes while they wait on payment. My doctor charges more because he knows that he will get less. The insurance company negotiates so that my deductible is rarely met. The drug plan is another tale. They send me letters to encourage me to take an “opportunity” to save money. They negotiate with the drug manufacturers to get the best price for the plan sponsor and themselves. Fine. But they turn down my doctors prescriptions because I didn't take advantage of the “opportunity”. So my choice is take the drug they want me to take or go pay 3 to 4 times as much.
I think this is all craziness. Capitalism at its best?
I don't mind businesses making a profit. I don't mind health care professionals making money. However, isn't this just about the same as the “Wall Street” greed we are seeing lately? Shouldn't we all; corporate America, doctor, hospital, drug supplier, drug manufacturers, and yes, the public change our ways and our expectations?


Posted as comment on NYTimes.

There is a big long on-going story behind my comments but it would be too long to post here.
PS After rereading the comment to the Times, I realized the whole thing relates to the April 25th blog post.