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Government run Health "Care" - A testimonial So you are all for the government running or being part of your health care needs? If you have ever dealt with Medicare/Medicaid or the military retired benefit of Tricare, which is now emulating Medicare per its allowances and administration, then I don't need to say more, but for those of you who have not had such dealings, be warned. During December of 2008 I suffered a heart attack while at my home in the Philippines to which I have retired to. I was then rushed to the nearest emergency room here in the Philippines with my understanding that my military health care would cover the costs and that the hospital would simply bill my insurance as is done in the U.S. Wrong assumption. I quickly found out that Tricare will not accept such claims and that I must pay all the costs up front and then submit my own claim for reinbursement. Okay, so how many of us have ten thousand dollars in cash laying around for such a purpose? Needless to say, I had to scramble to come up with such funds, all within the 30 days the hospital gave me before they imposed a 25% fee. Thankfully I was lucky enough to have enough family and friends to help me meet that deadline, had I not, I would still by trying to pay it in full and would of course miss the one year deadline to file a claim for reimbursement, a nice catch-22 for ya. Okay, so a month after release from the hospital, I submit my claim and all of its required documentation, sent via FedEx as regular postal mail takes at least six weeks on a one way trip. For the next two months I checked the status of both my claims online, as I had to seperate in-hospital medications onto a seperate claim. During those two months, the claims showed a status of "in process". Shortely afterwards, I get a call from the hospital asking me what I want them to do with a letter from Tricare asking for my medical records, keep in mind that the hospital is fully paid and has no reason to be involved or get involved with my claim. I fetched the letter from them, gathered up the medical records and FedExed it all back to Tricare. I wait another few weeks noting that the claim status has yet to change, so I called them (long distance on my phone bill) only to find out that they had sent another letter to me asking for more records. So I wait another six weeks and recieve the letter, which stated "we are waiting for records from the hospital", with no mention of what exact records they require, as they have my claims now under "medical review". I gather up any and all records available to me and send them off via FedEx once again. During the four day transit of those records, my claims were suddenely listed as "denied". I of course called to find out what happened only to be told that my time to file the claim had expired, since you are given one full year to file the claim, not to include the time it takes to process the claims, but to first file it, I was at a loss since I had filed it within one month of my release from the hospital. A half hour of going back and forth with "customer service" it finaly dawned on them that they had their years mixed up? So two new claim numbers were issued and I thought that would be the end of it. I then get another letter asking for more records, nothing specific again, just a form letter with every possible catagory checked as being needed, including therapy records, which made no sense since I never had therapy nor claimed any costs for therapy. Just goes to show you how no one was taking any time to actualy review the claim. So once again, I gather any and all records from the hospital, which took a great effort as I had to have a clerk spend her time chasing down every possible record once again and have them time and date stamped as verification of their being true copies. So off to FedEx once again. Four days later, they are recieved by Tricare per FedEx tracking. That same day they recieved the records I check my claim status and they are both pegged as "Paid". Wow! That was really fast service! Well, when I noted that my claim for 3 thousands dollars worth of medications was paid out to me in the amount of 2 hundred dollars, I was extremely shocked and called once again only to be told that no one had yet looked at recently recieved records (that they requested). So why would you request records and keep the claims on hold only to recieve the records, not look at them, and then make a decision? I was assured they would review the claims again and make any adjustments, but they could not explain to me the vast difference in the amounts claimed and paid other than to tell me that maybe the hospital simply over charged me and that I should go to the hospital and ask for a refund? How do you refund something that was consumed as well as ordered by a doctor as well as accuse the hospital of such a thing. A futher explanation was that my military health care now falls under the same guide lines as medicaid as well as the fact that I have to co-pay 25% of everything now. To date, I am still waiting for the promised letter explaining the dollar differences in my claim. Which I then will have to submit a request for a further review. Some how I am not taking much comfort in there being any resolution to this, leaving my wife and I to repay personal loans for health care that was supposed to be due me. And that folks is your government run health care in nutshell. Enjoy yours when the time comes! Chuck
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Group: Moderators
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And while I'm freaking out, might I add that I had recently recieved a letter from the social security admin explaining my benefits, which showed that with the tens of thousands of dollars that I have paid into the system over the course of my working life, I will get about a thousand dollars a month once, and if, I reach the required age. Great! BUT.... 75% of my military retirement will be deducted out of that thousand dollars a month meaning that I will be lucky if I get two hundred dollars a month for a few years before I drop dead. Sounded like a great "security" plan for the costs that I paid into it.... Isn't government just wonderfull in their ability to manage everything they are into? I wish I had the senators retirement plan, after a four or two year term, they get the same amount paid every year for the rest of their lives!!! Sign me up please! Chuck
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Group: Administrators
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charlesr1958 (8/1/2009)
Isn't government just wonderfull in their ability to manage everything they are into? I wish I had the senators retirement plan, after a four or two year term, they get the same amount paid every year for the rest of their lives!!! Sign me up please! Chuck Me too
________________________________________________ Keith "Simply put, you believe that things or people make you unhappy, but this is not accurate. You make yourself unhappy." Wayne Dyer
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Group: Moderators
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| Well yesterday I called Tricare again to ask about the vast difference in what they paid and what I had claimed for. I was told flat out that what I recieved will be it, and it is not something I can appeal as their guidelines are set and thats the end of it. The woman I talked to at least took the time to go through some of the line items as examples of what they can and can not do. But on average, if a medication costs you 50 dollars, they pay about 10 dollars, but only if the medication is first deemed by them to be actualy required, most of mine were deemed as unneccessary... So if there is a next time, I guess I should study medicine so I can inform my doctor what medications are actualy neccessary or not per any condition that should strike. I guess the devil is truly in the details as I was promised health care in return for 20 years of service, I just never thought to ask what quality of heath care I would be recieving. Now I know. Chuck
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From up in The Great White North ...
When I need my kids need a checkup / vaccination / what have, I call up our doctor's office. Show up, hand our health cards over to the receptionist, wait a few minutes ... and go in to see our doctor.
No paperwork. No money exchanging hands.
No one second guessing whether or not the visit was necessary.
For emergency medical care, it's basically the same deal only at whatever hospital's closest. The cost of getting there isn't covered, but I'm not limited in my choice.
My kids get free vaccinations, but most meds are covered out of pocket. But ... the federal government sets a cap on the price of most medications, so common prescription drugs aren't of the cripplingly expensive variety.
My dad used to have a restaurant near a hospital in the States. Guys used to go from the hospital to the restaurant's bathroom to stage slip and fall "injuries" all the time to cover hospital bills. Quick settlement, $200 "or I call the lawyers." Stuff like that doesn't happen in most other Western countries.
Some time, you should rent Michael Moore's Sicko. He plays up how good different systems are ... and how bad the American one is ... but there are grains of truth in the central premise that profit-driven health care tends to suck for many people.
I think the problem is really that few Americans have little experience with anyone else's health care systems from the viewpoint of citizens, beyond hyped-up media reports about tourists have disasters in third world countries.
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| The kicker for the states and why you can't really compare is the simple fact that if the U.S. government is involved, in anything, you can guarantee that it will be extremely inefficient and bogged down with regulation. Socal security, medicare/medicaid are but a few good examples. But my biggest issue with it all is simply the fact of there being any government involvement at all. Its just not "american" and flys in the face of my ideals and work ethic. But when you elect a socialist who admires Marxist view points who now uses unions as a club, I guess we can expect more of the same. I just find it kind of ironic that I spent 20 years guarding against communism (cold war) only to see it making headway in broad daylight. At this time of economic hardship, might we take a peek backwards in time and be aware of the political (historical) dangers that are possible when a nation pins its hopes on a single person. It was not long ago that another smooth talking Johnny come lately ran on the "change" platform during the great depression and millions paid a heavy price in the end. Chuck
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Hi Chuck,
The US spends more money, per capita, on health care than any other nation on Earth. But the US comes in at 38th for life expectancy, well behind the two nations it most resembles, Canada (11th), and the UK (22nd). In fact, the US is behind Chile and Cuba and just squeaks ahead of Slovenia.
Pretty clearly, the US isn't getting particularly good value for the money spent. And getting decent value for your money /is/ an American ideal, and that's been one of the cornerstone arguments about why functions that most states handle in the West are often shifted to outside contractors and businesses in the States. Something got busted along the way, for health care at least.
Another way to look at it is that decent-sized American businesses generally offer health benefits to employees, paid for by the business. Foreign companies (at least those in the developed world) don't have to offer health since the State already does, which shifts the burden off companies making them a little bit leaner. In fact ... one of the reasons why The Big Three tanked harder than most foreign car companies is that The Big Three are getting hammered by paying for medical benefits for some workers who've been retired for 30 years. One way to look at the bailouts is that the US has written some rather large cheques to cover these workers' health benefits.
One more story. My wife's family is from the States. Her grandma, slowly going downhill, went to live with my wife's family in Canada a while back. Shortly after moving, she was diagnosed with cancer and died about six months later. I remember being at their house while my mother-in-law was having shrieking matches with her mother's HMO along the lines of, "She's been diagnosed with CANCER. She's too sick to go back to the States." "Yes ma'am, but our doctors have to verify the diagnosis. We won't pay her bills until she's been diagnosed by one of our doctors." And on and on. They nickel and dimed everything, from the home care nurse to the morphine. Even though the cost of her care was a fraction of what it would've been back at her home hospital. And the woman had declined chemo and radiation therapy, "I'm too old and worn out for something that'll make my life hell for 6 months longer."
Now ... I don't know the medical histories of many Americans, but the fact that I can come up with stories like this suggests that the system needs, at the very least, a few kicks. And nationalising health care and capping the price of drugs are, at least, a couple options that shouldn't be rejected out of hand.
Sometimes, pragmatism has to trump idealism.
Jason
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| As for value, I'm sure there are a lot of other factors involved, none of which I believe are related to quality of care available, when it comes to the life expectancy figures. The U.S. leads the world in quality health care and with high quality comes a higher price, same for any other commodity. As for the life expectancy numbers, I would expect the U.S. to be lower simply due to the typical life styles. Obesity, heart clogging diets and so on. Here in the Philippines, they have quite a high life expectancy but surely not due to their quality of care, and what care is available, is not quite available, yet most filipinos are very healthy from what I have seen, and a lot of that is due to their diet of fish,vegetables and rice along with putting in a good physical day, that and obesity is no where near as common as in the states. Granted, as with anything, there are tweeks to be made, and might some simple reforms of the regulations along with limitations on law suits be enough. But to hear some senators push for a single payer system as is the Canadian system simply to insure ten million peaple and create even more dependant voters (funny how the "poor" tend to be democrats), and such a socialist system might be okay for basic care such as immunizations and such, but get seriously ill and we have all heard enough horror storys to know it is not something to brag about. That... and I am just dead set against socialistic government systems/programs in any form. There is yet to be an example of such that anyone could be remotely proud of or even simply satisfied with. But, maybe I'm a dieing breed of american and hope I am not around to see our nation turn into a bunch of entitled sheep. Freedom is far from free, yet so easily given up by many when the free lunch rolls into town. Sorry, I seriously doubt, no matter the arguement or reasoning, that I will ever be able to stomach, nor stand for, socialism, communism and other like minded controls and denials of liberty. I hate to admit this, but out of an act of frustration, anger and the old "what ifs", I recently checked into what I would have to do to give up my citizenship, I figured if I was no longer a U.S. citizen, I wouldn't give a crap anymore and not fret over what I see happening. But... turns out I am not technicaly "retired" from the military and am on "retainer", meaning that if I give up my citizenship, I give up the source of income that I earned. No can do. Edited to add: I also wanted to say that personal responsibility not only comes from such freedoms, but should be something everyone is held to. BUT... I am in favor of limited, short term "hand ups" (not hand outs!) when circumstances warrant such as losing a job, but only just long enough to get one on their own feet again and then cut them loose. Same as insurance, if someone is so irresponsible as to forgo insurance when they can afford it and then get into an accident, then its on them to pay their own bills as they, not me, took that chance. For those at poverty level, again, a limited term of medicaid/medicare would be okay, but at the same time, some investment into their education (loan?) would allow them the chance to better their situation, if they then decline and are comfortable with living in poverty, then so be it, you're on your own then. I also want to make it clear that the above situation per my heart attack was all of my own fault. It was my responsibility to look into what would or would not happen should I need medical care, which I did not and simply made assumptions that cost me, no ones fault but my own for not researching the what ifs. My issue is that once I followed the steps as mandated, I was further denied and limited in basic needs for such a hospital stay, its not like I had a spa in my room. Also, when I was at the ranks of E1 through E4, I at that time qualified for food stamps, yet I never availed of it simply because I don't believe in it and was able to work within the budget I had, it would have been easy to take it as a freebie yet without it, we still did not starve. When I got out of the Navy after my first four years, I too qualified for unemployment, yet never took it either as I knew that I was out of a "job" because I made that decision, not my employer, or the tax payers for that matter. Chuck
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