Monday, September 21, 2009

A Discussion of Health Care

Most of the people talking about Health Care have had nothing but company provided Health Insurance. I however, have experienced the entire spectrum and now exist on Medicare/Medicaid. Prior to 1968 I was, for the most part, covered by my Parent’s Blue Cross Blue Shield insurance. Between 1968 and 1984, I worked for General Tire in Akron, Ohio, and had wonderful health insurance. In 1968 once I met personal medical expenditures ($100 @ individual or $300 @ family) I was reimbursed 100% for any further costs. When I left in 1984 to work in California, I don’t remember if the limits had changed, but the reimbursement was changed to 80%. I had just recovered from a major shoulder operation; I was 37 years old and in great physical shape.

While I was in California, from 1984 until 2000, I worked for three different companies and had a couple of choices but the best for the money was always the HMO, Kaiser Permanente. I found out that you had to be careful about which Doctors treat you. I found some really good ones but I also seemed to be lucky enough to usually get the ones that wanted the large bonuses available to those doctors who could save the company money. When I left California I had gained 100 pounds and therefore developed Sleep Apnea (diagnosed when I was almost dead according to the ENT that initiated my testing); I had been treated for depression during this time when the depression was caused by lack of sleep; I had type II diabetes, which had not been diagnosed, I had a skin infection that they treated as a rash (I still have this but not as bad due to the diabetes). I also had a ruptured disc in my back that had been misdiagnosed as a sprain for six months and a punctured eardrum from having a tube put in my ear that has never healed. I had been diagnosed has having bronchitis two times when I actually had pneumonia and had been treated for an ulcer when I had GIRD (never had X-rays).

When I came back to Ohio in 2000, I was sick (Pneumonia again) but had no insurance at all. I went to the Free Clinic in Akron and was checked for Diabetes; for Pneumonia; and Gird. In Columbus, Ohio I finally got insurance though the State of Ohio and it was good, but I became disabled because of all the health problems along with a knee that had been operated upon twice that got diagnosed (when I had the State Insurance) as having Degenerative Joint Disease and recommended for knee replacement. That was in 2006 just before my being certified as unable to work by State of Ohio Doctors and released (I had until 2009 to get better and return to the same post I had held, but I got worse instead).

I was not qualified for Medicare at that time, so I was placed on Medicaid. I could not afford the Spenddown each month to receive Medicaid Benefits because it was set at everything I made over $420 @ month (which was wrong I found out later). Since my rent alone was $500 @ month, I applied and got accepted to a waiver part of Medicaid that offered more benefits for a lot less and eventually I qualified for Medicare and now that is my primary insurance with Medicaid as my secondary.

Since I am married and my wife is not on Medicare or Medicaid, I had to provide for her. We found Doctor’s, in both Columbus & Akron, Ohio) that charge based on the ability to pay and we pay $20.00 per visit for her. I carry a $127.00 per month major medical policy for Emergency Hospitalization and we purchase her medications at $4.00 a month each for five prescriptions.

I gave all of this background to show you I have been under all types (including none) Health care. I found out about some facts that many people do not know because it is not information freely given. One fact is that since the Medicare/Medicaid reimbursement is something like 67% of the billing, most hospitals and doctors pad their bills (for all patients) and if you tender them 75% of your bill (when you have no insurance) in one payment they will consider the bill paid in full. That’s because everyone’s bill is padded because the Hospitals, Doctors and Technicians do not know what your insurance (if you have it) will actually pay and they actually get more when you pay them 75% of the bill in one payment. Therefore, when Politicians suggest cutting reimbursements, yes, the will save that money but the providers will either pass the difference on to the patient or stop taking Medicare/Medicaid patients. This affects the President’s pledge that you can keep your same doctor because no one knows if your doctor will take the reduced reimbursements (for either Medicare or Medicaid). If the cost is passed on, people will either have to pay higher co-payments or States will discontinue what they cannot afford. So either the patient pays more out of pocket (another promise that Barack Obama cannot make) or the patient has to opt for the Government plan which is the Left Wing radicals’ hidden agenda to move to a single payer plan.

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