Surgery on a Sunny Afternoon Got Me Thinking About Healthcare

Submitted by divineorder on Sat, 10/27/2018 - 1:52pm

049-800x600 eagle fish Essay_0.jpg Millions young and old, caught up in the struggle for Healthcare and now there's a consensus.

Yesterday we caught the bus downtown to the Dragon Room in the Santa Fe Plaza area for Happy Hour to meetup with friends we hadn't seen in a year. Heh. As happens with we seniors, part of the time was spent catching on health issues.

Our friend is facing knee replacement surgery with complications. Carpenter property manager by day, musician by night, he was worried about how things would turn out. But at least he had coverage through his wife's employment. Millions still don't have healthcare, and many who do, face denial of coverage and worse.

It clearly is a huge issue for some in the upcoming midterms.

Senior or no, perhaps you, too are worried about how things will turn out?.

Medicare Advantage vs. Medicare for All https://t.co/EFG1G4QKCS

— Alice Marshall (@PrestoVivace) May 31, 2018

For those who followed the healthcare debacle during Empty Suit era it has been gratifying to see the coverage and movement toward single payer.

But there are still serious obstacles.

Dr. @awgaffney details the barriers to #SinglePayer reform: "Obstacle number one is the corporate opposition, obstacle number two is the potential that #MedicareForAll could be co-opted or sort of mutated into a lesser thing." https://t.co/E4xTSBPx2E via @businessinsider

— PNHP (@PNHP) October 26, 2018

Here's another link for those who want to educate themselves on MA vs IMFA.
http://healthoverprofit.org/2018/03/27/medicare-advantage-vs-medicare-fo...

Over the last few decades, insurers participating in Medicare Advantage have schmoozed Congress into compensating them with more money per person than is allocated to traditional Medicare. Don McCanne of Physicians for a National Health Program writes:

“Each year the administration, whether Democratic or Republican, uses quirky arcane rules to ensure an adequate revenue buffer so that private insurers can compete favorably with the traditional Medicare program by offering lower premiums and cost sharing and expanded benefits… Once a critical mass has enrolled in private plans, Congress will gradually reduce the relative value of the voucher-equivalent, reducing the government component of the funding of Medicare by shifting more costs to the Medicare beneficiaries.”

We see this happening right now, with top leaders of Republican Party expressing a strong interest in cutting Medicare. In response, physician advocates argue that the private Medicare Advantage HMOs should be isolated as a source of wasteful government spending, and that benefits offered by these plans should be expanded into traditional Medicare. Physicians for a National Health Program (PNHP), the doctor-led think tank for single payer policymaking, has been putting forward a strong case against Medicare Advantage for some years.

PNHP points to a number of studies that show the Medicare Advantage HMOs cherry pick healthy patients and lemon drop expensive, unhealthy ones. This is done through narrow coverage networks and poor access to specialized care , driving patients with heavy medical burdens into traditional Medicare – where they can choose their own providers. A 2015 Brown University study showed that of Medicare Advantage patients who had long-term stays in nursing homes, 17% switched to traditional Medicare the next year. The report’s lead author, Momotazur Rahman, told NPR news that there are incentives, including “steep cost-sharing as patients need more expensive care” and “limitations on expensive treatments”,that because sick patients to drop out of Medicare Advantage plans. A 2017 Government Accountability Office (GAO) report found that of 126 Medicare Advantage plans, 35 plans saw disproportionally high numbers of sick enrollees dropping out into traditional Medicare.

In 2017, a Kaiser Family Foundation (KFF) study found one out of every three Americans enrolled in Medicare Advantage plans were given narrow physician networks. It concluded that plans offering broader networks tended to have much higher premiums than narrow-network plans. KFF also found that one out of every five plans do not include a regional academic medical center in their networks, and estimated that 40% of Medicare Advantage networks included top-quality cancer centers.

The Medicare Advantage insurers can also increase their profits by upcoding the severity of the diseases that their patients have. HMOs are paid per capita based on the number of patients they cover. The payments are also risk adjusted according to the severity of the illnesses of those covered: the more severely ill, the higher the compensation. So it is to the Medicare Advantage plans’ advantage to upcode, to make patients seem sicker. Investigations by the Center for Public Integrityand the work of academics show that there is both direct and indirect evidence of massive upcoding in Medicare Advantage, costing the government and taxpayers tens of billions of dollars.

While Medicare Advantage is not an efficient or an equitable means of offering care to senior and disabled Americans, it’s important to look into some of the benefits that satisfied patients (who tend to be healthy) are grateful for. All of these benefits would be offered (and enhanced) through a national health insurance system like National Improved Medicare for All (NIMA).

Sorry for leaving out the extensive hot links in the above quote.

So as before its a crapshoot that the Dems and their Repub buds won't screw this up for us.

My wife C99er jakkalbessie and I rode our pedal assist bikes down the Arroyo de Chamisa Urbano to the grocery store this morning, and it is one beautiful fall day here in
The City Different. Leaves are changing, there's a little snow up on the mountains east and west. Such a glorious day to be alive, and able to pedal around still!

I got to get my butt in gear and get ready for MOHS surgery. Spending too much time out in the sun, I guess.

Running through my mind are thoughts like " How much will I have to end up paying? Will my Medicare Advantage Employer group coverage try to deny it?"

What if I were like millions, with no coverage at all? My brother has a much larger problem on his face and no insurance what so fcking ever.

It's all but guaranteed that Trumpco will finally strangle ACA to death and soon. And then there's the worry about how corpadems can fck everything up.

What are people going to do? All the best to you and yours, good health to all.

Of course its not just we mouldy odies that care about this sheet.

AP-NORC/MTV Poll: Young people back single-payer health care https://t.co/pnBGhCq0Pq

— Health Care For All (@HCASFV) October 26, 2018

Young Americans called health care a very important issue in deciding how to vote. Sixty-two percent of those who will be old enough to vote in the midterms rated it as such. That’s the most who said the same of any issue in the poll, including... https://t.co/K2oMRAXPRz

— Big Easy Magazine (@bigeasy_mag) October 27, 2018

More power to us all.

Wish me luck! Hoping to be in the 94% success rate for this surgery. Divineorder.

Tags:

Medicare

Medicare Advangage Private

Medicare for All

Single Payer

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Comments

Submitted by divineorder on Sat, 10/27/2018 - 1:59pm

Good afternoon, c99ers! Hope you are having a good one.

Apparently there is downtime during the day surgery but in case the local has me knocked out will check back for comments laters.

—

A truth of the nuclear age/climate change: we can no longer have endless war and survive on this planet. Oh sh*t.

Submitted by smiley7 on Sat, 10/27/2018 - 2:30pm

Hey, brother, good vibes for the surgery coming your way;

and, thank you for this essay as most don't understand the consequences at hand, too complicated and muddied by propaganda. Even with Traditional Medicare, i've had to battle one hospital and two doctors for what is known as double-billing; same with my Mom.

And as you articulate, there is a huge chance that the insurance lobby along with the vendors of healthcare will twist Medicare for All into an advantage plan and that's the last thing we should do. It's a boondoggle and profit center for insurance companies.

Mollie often says Traditional Medicare is the way to go and i agree. Wish you and JB could change to it with plan F before 2020, when, if i'm correct, it goes away, a deal Obama made with repugs in 2014, i recall. Mollie will know.

Having said the above, joining you in empathy for those without coverage or folks like my daughter-in-law who, because of cancer and is young, has to pay huge out of pocket costs just for the tests she needs annually, it's a mortgage payment to live, damnit.

First off and maybe against some grain here, vote, we must stop this incorrigible leader now. This may be the only revolution available to us, we, in the short term.

Then move forward best we can with the young people who have it together, we owe them a shot and better world.

I'm running on, thanks again, do; sending love and healing thoughts.

Submitted by divineorder on Sat, 10/27/2018 - 4:02pm

Thanks smiley7!

@smiley7 It's a big ask to get people to take this on, isn't it, to study the ins amd outs and pros and cons? Getting info must be much easier than before with all the online resources. I like to plow twitter to see comparative articles.

But so much depends on people getting a grip on it, having a say, and taking it.

Have not heard of plan F, thanks, will check it out. Our teacher retiree health benefit is still in funding crisis so need to be more prepared for alternatives.

FWIW when the current funding problems began as we approached 65 we teachers were all moved into Medicare Advantage with option to move to Trad Medicare later. After talking with specislists we were seeing that's what we did, Trad Medicare plus reiree benefit as secondary. One thing that was nice with MA was only one bill instead if two pay parts for most things.

This year the legislature forced everyone back into MA and Humana took over from Aetna. AFAIK some 30,000 65 older teachers, many in rural areas, left the plan and most can't return. Many of those left because specialists in their geographical area were not in network in their area. Others fell victim to loyakl salesmen who gave cheaper premiums but less or poorer coverage.

Mollie is way ahead on the learning curve, we are fortunate to have her input. Jb and I are getting there but still have a great deal to learn.

All the best to you and yours!

—

A truth of the nuclear age/climate change: we can no longer have endless war and survive on this planet. Oh sh*t.

Submitted by ggersh on Sat, 10/27/2018 - 4:28pm

Medicare Advantage big meh

@smiley7 Medicare for All, meh

we should all have what our glorious representatives
have $500 per year 100% coverage

We are getting fucked everytime clowngress passes
a bill, bipartisan or not.

Corporations and their CEO's have joined the long
list of those screwing ordinary amerikans, one would
think corps would benefit from more money in peoples
hand to be able to purchase more, but that template
has long passed to corps receiving welfare hence sales
no longer matter.

amerikans since Raygun have seen everything crapified
and I mean everything, quality goods are no longer
made, quality service is no longer available, good
all amerikan know how is amerikan shit show.

—

I never knew that the term "Never Again" only pertained to
those born Jewish

"Antisemite used to be someone who didn't like Jews
now it's someone who Jews don't like"

Heard from Margaret Kimberley

Submitted by smiley7 on Sat, 10/27/2018 - 5:36pm

This isn't a 'meh' choice, but an empirical one.

@ggersh

Plan F covers 100 percent of extraordinary needs; doesn't cover trial drugs or unproven procedures. It's the best coverage in the world, given that one can choose their doctors, specialists and hospitals plus go after additional special opinions.

It's a money maker for insurance, too, as medicare pays the lion's share. Premiums cost, presently, around two grand a year and it's working; not $500, like congresscritters, mind you; but not unrealistic to see an economy of scale reducing those with 200 million more payers into the plan: win, win, win all the way around.

Submitted by ggersh on Sun, 10/28/2018 - 9:17am

Smiley to say how very "empirical" it is

@smiley7 this is the first time ever I've heard
of Plan F... why cant all amerikans have that,
rhetorical

—

I never knew that the term "Never Again" only pertained to
those born Jewish

"Antisemite used to be someone who didn't like Jews
now it's someone who Jews don't like"

Heard from Margaret Kimberley

Submitted by smiley7 on Sun, 10/28/2018 - 5:45pm

Plan F covers both Medicare deductibles and all copays ...

@ggersh

This article explains plan F:https://boomerbenefits.com/medicare-supplemental-insurance/medicare-supp...

Medigap Plan F is the most comprehensive Medicare supplement you can buy. Plan F covers both Medicare deductibles and all copays and coinsurance, leaving you with nothing out of pocket.

It has also been the #1 seller with Baby Boomers for many years. According to a report from America’s Health Insurance professionals, about 57% of all Medigap policies in force were a premium Medicare Plan F policy. (In recent years, Plan G has been the second most popular Medicare supplement plan, and you can read more on that below.)

Medicare Plan Quote ButtonA Medigap plan, or Medicare Supplement, pays after Medicare to help cover your deductibles, copays, and coinsurance that you would otherwise be responsible for. Medigap plans do not replace your Medicare Part B. You must be enrolled in both Part A and Part B first, then you are eligible to enroll in Medicare supplement Plan F.

When you add a Medicare Supplement Plan F or G to your Original Medicare benefits, your coverage will be quite comprehensive. By definition, Medigap Plan F is the Medicare supplement policy with the most benefits.

(Sometimes people refer to Plan F as Medicare Part F or Medigap Part F, but correct terminology is Plan F. Just remember: only Medicare itself has Parts.)

Other Traditional Medicare plans are not as comprehensive as plan F. Insurance agents push people into other plans and as i said above most try to sell the Med. Advantage plans. As you see 57 percent of Medicare patients have plan F. Again, i highly recommend anyone on or nearing Medicare to check out plan F. One expensive MRI, for instance, in a year more than covers the annual premium compared to plans that have high co-pays.

Submitted by ggersh on Tue, 10/30/2018 - 5:20pm

Thanks for putting that

@smiley7 Medicare Plan F info out there

—

I never knew that the term "Never Again" only pertained to
those born Jewish

"Antisemite used to be someone who didn't like Jews
now it's someone who Jews don't like"

Heard from Margaret Kimberley

Submitted by divineorder on Sat, 10/27/2018 - 4:49pm

Hey ggersh, I can't argue with that!

—

A truth of the nuclear age/climate change: we can no longer have endless war and survive on this planet. Oh sh*t.

Submitted by snoopydawg on Sat, 10/27/2018 - 4:55pm

Good luck with your surgery

Before congress takes an ax to our programs they should have to give up theirs first. Besides every one of them can afford to pay out of pocket and would hardly notice it.

Instead of MFA I think every one should have Medicaid and just have congress fund it. People can buy private insurance for things that it doesn't cover. Or congress should make it cover every thing.

—

Scientists are concerned that conspiracy theories may die out if they keep coming true at the current alarming rate.

Submitted by divineorder on Sat, 10/27/2018 - 5:35pm

Thanks sd.

@snoopydawg And Yes to Medicaid for all.

—

A truth of the nuclear age/climate change: we can no longer have endless war and survive on this planet. Oh sh*t.

Submitted by on the cusp on Sat, 10/27/2018 - 5:21pm

d o,

2 of my best pals had that surgery this year, and they both got the "all's clear" result.
I hope you will come away just fine and dandy!
My Medicare supplement is through United Health Care, a plan through AARP.
I have been aggressively pursued by United to switch to their fabulous Advantage Plan because I will save so much!
I am very mobile, can't guarantee I will get sick or injured within an ambulance trip to a network hospital, or that network approved drs. would be within easy driving distance. I live in a rural area. Just buying a pair of shoes might entail an 80 mile round trip.
I expect them to double down on their campaign to "save me money" in the upcoming months.
The Advantage plan is going to appeal to millions of people who do not understand the fine print.

—

"We'll know our disinformation program is complete when everything the American public believes is false." ---- William Casey, CIA Director, 1981

Submitted by divineorder on Sat, 10/27/2018 - 5:39pm

Thanks, got the all clear on those

@on the cusp 2 now meet get a complete scan since did not get one recently.

And otc the Trump admin has already began the big sell for MA.

—

A truth of the nuclear age/climate change: we can no longer have endless war and survive on this planet. Oh sh*t.

Submitted by davidgmillsatty on Sat, 10/27/2018 - 5:24pm

Never underestimate

The ability of austerians to underfund or defund a good government program that works for all.

Submitted by divineorder on Sat, 10/27/2018 - 5:42pm

Davidgm you got that right! :)

@davidgmillsatty But we should fight back like e mean it, no?

—

A truth of the nuclear age/climate change: we can no longer have endless war and survive on this planet. Oh sh*t.

Submitted by davidgmillsatty on Sun, 10/28/2018 - 3:05pm

But here is the elephant in the room everyone overlooks

@divineorder The federal government can mint or print all the money it wants. Don't believe me? Thought experiment. Consider a quarter. Ask yourself if the federal government had to borrow or tax to mint that coin and put it in circulation. The answer of course is that it did not have to do either. Now states and local governments can not mint coins or issue any kind of paper money and they have to borrow, tax and budget. The federal government does not have to do that. It can mint coins until we run out of metal. And then it can still print paper.

That is the problem with the Austerians. They don't believe the government can actually issue money out of thin air, or they believe that if the government can and does, then there might have dire consequences for the economy. But there never will be dire consequences if the government spends the money it mints or prints on things that need to be done such as healthcare for its citizens.

Submitted by snoopydawg on Sat, 10/27/2018 - 6:36pm

Whenever I read something like this

It's all but guaranteed that Trumpco will finally strangle ACA to death and soon. And then there's the worry about how corpadems can fck everything up.

I think how Obama had the chance to pass single payer and didn't. The republicans wouldn't be able to touch it because people would love what they had. He. Had. The. Votes to pass it. He just didn't.

—

Scientists are concerned that conspiracy theories may die out if they keep coming true at the current alarming rate.

Submitted by divineorder on Sat, 10/27/2018 - 8:29pm

Hoodwinked, eh sd?

@snoopydawg

You mean "hoodwinked" like we were when you said "if you like your doctor," if you like your insurance," lies you brazenly told to sell ACA? https://t.co/yk1TmBfEYp

— william johnson (@william09128149) October 27, 2018

—

A truth of the nuclear age/climate change: we can no longer have endless war and survive on this planet. Oh sh*t.

Submitted by wendy davis on Sun, 10/28/2018 - 7:38am

best thoughts for your mohs procedure, divine order.

i'd wondered if by 'health care' in your title if you might have meant 'health insurance'; seems you had.

they're pretty different, of course, but as i've been the victim of medical malpractice many times, as had my parents (a genetic trait?/s) i'd thought you might have been going to rant about that. surgical errors, iatrogenic diseases of all sorts, from bigPharma, acquiring superbugs in hospitals, etc.

a Q though: so many with obamaDontCare rail against it, or did until DT threatened to take it away. the Good News is that i get junk mail for trump medicare, but then i get christian insurance, too. ; )

Submitted by divineorder on Sun, 10/28/2018 - 8:03am

Hey thanks for the kind words wd.

@wendy davis

Doc read the slides and said she got the remainder of the cancers after only one cut. Guy in the next room was apparently a vet and was not having a good go of it.

Nah, I was thinking of healthcare when I wrote the title, about my brother's many health challenges and lack of affordable health care available to him, then I went off on tangents as some of us are prone to do.

Several of of us here have a years long running conversation on health care and health insurance options, often conducted in the Evening Blues. Complex subjects, just threw this up here on a Saturday afternoon to see what peole had to say today.

Thanks for your concern that I didn't understand the difference between healthcare and health insurance.

—

A truth of the nuclear age/climate change: we can no longer have endless war and survive on this planet. Oh sh*t.

Submitted by wendy davis on Sun, 10/28/2018 - 10:38am

i'm glad to hear that your news is

@divineorder

so good, amigo. me, i don't need health insurance cuz i'll never go to another doc as long as i live. luckily mr. wd knows that, too. a variation on a Living Will?/s ; )

Submitted by divineorder on Sun, 10/28/2018 - 11:25am

May your health be strong and your pen last long! :)

@wendy davis

—

A truth of the nuclear age/climate change: we can no longer have endless war and survive on this planet. Oh sh*t.

Submitted by wendy davis on Sun, 10/28/2018 - 2:02pm

what a nice wish,

@divineorder

but truth to tell, most nights when mr. wd and i get in bed we're feelin' so 'rode hard 'n put up wet'...we chant 'kaching! another day over' like prisoners chalking off days on the wall. then we boot up our crap $40 dollar waldo-world dvd player that says: "Life's Good!" and sometimes fairly wee our britches laughing. we're waitin' for the Grim Reaperess to come for us, she's the One who'd let us go to the great beyond...together, as neither of us wants to go first. be kinda kool to have the opposite of a Life Alert chain necklace, one that would be Easy Death on a Chain.

but srsly, thanks for the wishin'.

Submitted by OLinda on Sun, 10/28/2018 - 2:10pm

Not impressed with Medicare

Don't know why everyone is all "Medicare for all." We deserve universal health care paid by the govt.

I have a $200 deductible, before Medicare pays anything. Then co pays on a few prescriptions I needed. Then 20% of a PET Scan and 20% on another test. Hundreds of dollars I don't have. As a senior on Social Security, this kind of extra money in addition to the money taken out of SS for Medicare is not available. Not sure what I'm going to do. Scheduled to have surgery in Nov. Can't wait to see my share of that!

Got eyes examined with hopes of getting needed glasses. Can't get them now with these other medical expenses. No contribution from Medicare for glasses.

Submitted by divineorder on Sun, 10/28/2018 - 2:39pm

Right! Your situation is duplicated among millions. What a

@OLinda

croc of sheet! You have my deepest sympathies. I have relatives that won't even qualify for Medicare when the time comes.

Trillions squandered on War Profiteer Welfare. What a country!

Heh. Compared to our previous state / district health care back when we were teaching it is crap.

But Medicare has saved so many from bankruptcy over the decades, and has a big supportive following, that I think activists hope to capitalize on it's popularity and expand it to more age groups.

We each have annual $500 deductible and something under 3000 out of pocket limit. Monthly premium as well . Copays on drugs. But this is because we have it as a employer retirement benefit which at 65 we had to enroll in Medicare to get to continue.

We need a change!

.@realDonaldTrump, don’t let @CMSGov raise drug costs for seniors with Medicare. Stop new #AnyWillingPharmacy rules and #ProtectPartD https://t.co/sBEYjnOEoO

— cRumpledPigSkin (@BrerBradshaw) October 27, 2018

—

A truth of the nuclear age/climate change: we can no longer have endless war and survive on this planet. Oh sh*t.

Submitted by divineorder on Sun, 10/28/2018 - 2:24pm

Heh. FWIW, have Swiss friends we met in New Mexico years ago

while camping at a hostel in Truth or Consequences.

We have become quite close over the years, visiting each other back and forth in US and Suisse multiple times.

One of our last visits there in Zurich area we had a few glasses of wine and talk turned to recently deceased parents and then lead us to talk about assisted suicide. I was saying how difficult it was to do in the US, and they suggested I might want to move to Switzerland when the time comes. Haven't thought of it since then until your comment.

Would be an expensive proposition.

Apparently there are limits to who and what can be done.

David Goodall, a 104-year-old scientist and advocate for assisted dying, traveled from Australia to Switzerland this week to end his life by assisted suicide. https://t.co/D46brNMDEo

— NPR (@NPR) May 10, 2018

Meanwhile, the wingnuts in New Mexico are all upset about a purported push here.

Pro-Lifers in NM, be aware. This is a slippery slope & cannot pass! Get your friends to the polls in November.
New Mexico poised to push assisted suicide https://t.co/Wmgm2Ck8FR

— Sunni Rinker {} (@sunnirinker) September 20, 2018

—

A truth of the nuclear age/climate change: we can no longer have endless war and survive on this planet. Oh sh*t.

Submitted by divineorder on Sun, 10/28/2018 - 2:40pm

Ack this was meant to be part of thread of comments with

@divineorder wendy davis above.

—

A truth of the nuclear age/climate change: we can no longer have endless war and survive on this planet. Oh sh*t.

Submitted by edg on Sun, 10/28/2018 - 4:38pm

DIY MOHS

I'm 2 years away from Medicare. I cant' afford Obamacare ($830/month + $15,000 year in deductibles/copays). So I practice DIY MOHS on myself when needed using my fingernails to scrape off the growths. So far they seem not to be malignant, and I'm keeping my fingers crossed.

Submitted by MarilynW on Sun, 10/28/2018 - 6:03pm

Good health to you D.O.

One day soon, the US will have comprehensive health care. There are examples around the world so we know it can be done. Here in Canada, we worry about the surgery, the anesthetic, visitors, who will take care of the dog, but not about the money. Once the stranglehold in the US that is preventing it is lifted, it will become a possibility. Two more years...

—

To thine own self be true.