Gratitude Friday and Health Care

This is really a comprehensive list of questions you've asked. I don't have all my health insurance information easily at hand but I can give you a basic run-down of my family's situation.

I'm employed by a big international company and am also serving in the military part time so I have a variety of plans and options available. All of my health care issues that are even vaguely considered "military service related" are picked up by the Veteran's Administration. I have had a lot of tests done for neurological problems. I've also had a tumor removed from my eye. All of the treatments, exams, and medicine has been at taxpayer expense due to my 30+ years of military service and my combat veteran status.

For non military related illness and injury, and for all of my family's health care, I have insurance through work. My employer picks up a few hundred dollars and I have a similar amount deducted from each pay check. Most visits require about a $20.00 copay. Medicine is a separate account but is reasonable. I also have a flexible spending account through my employer that allows me to put aside additional money that can be used for medical bills. Dental and vision is all separate.

Through my employer I have a variety of health plans to choose from. I can also opt out entirely and go uninsured or pay into any other plan I can find. Due to health concerns I am enrolled in one of the more expensive plans, which cuts into my "bottom line" of income. I recently changed HMOs when I moved to the East Coast and found that my old plan is not offered here.

I used to live in Europe and my wife was a refugee from Czechoslovakia. We've separetely experienced various versions of socialized medicine over there and did not like it. I can give examples if you'd like but this is a real "hot button" issue with us and I'd like to keep the discussion civil. My biggest concern related to health care is that the government will take it over and manage it like they do the Post Office. Another concern, and one I've already experienced, is raising the cost of care for pre-existing conditions. I'm not eligible for certain long-term disability insurance due to, of all things, a back problem from 25 years ago that doesn't even bother me anymore.

What I like about the system and coverage that we have now is that there is a great deal of competition. I feel like the insurance companies and HMOs want my business and are trying different ways to get/keep it. Some go for low cost and try to get a lot of patients thus achieving economies of scale to cut their costs. Others take the high road and go for first class care and ask for more money. Still others go for the "niche markets" and offer specialist care. All of them are motivated by profit as much as the hippocratic oath.

I AM paying attention to the health care debate in the government and the media. I was especially interested earlier this year when the administration proposed charging veterans for the care they are receiving from the VA as a cost cutting move. This maneouver was defeated by the outcry from the Veterans of Foreign Wars, American Legion, and other veterans service organizations. That left such a bad taste in my mouth that I will forever be suspicious of this administration's intents in regard to saving money (the government's money, not mine) by manipulating the health care industry.

If I were ruler of the world I would try to tie health care with the education system in this country. The best hospitals here are those that are associated with universities. It's there where the research is being conducted to cure diseases like Multiple Sclerosis. Research money should spill over to the patients who are most in need of the products and techniques that are created. I would also push for tort reform. One of the main reasons for the high-cost of medical care and drugs is the ease with which doctors, hospitals, and pharmaceutical companies can be sued. Doctors have to practice "defensive medicine" in this country and this is wrong.

That's my long-winded two cents worth.

I'll only answer the first question.

I have three doctors, a family physician, a neurologist and a psychiatrist. I see the family physician at least once a year, but this year I've been four times. I am newly diagnosed with MS, so this year I will see the neurologist 4 times, at least two times next year, and hopefully only annually after that. I see the psychiatrist every 4 months. (this is all relapse dependent)

I also have access to a relapse nurse, physiotherapist, social worker, nutritionist & a opthamologist. I haven't been to the nutritionist or the opthamologist yet this year, but will see them before the year is over. I've been helped by the relapse nurse and social worker at least once a month since January, and I was just with the physiotherapist a few weeks ago. I follow up with her in October unless I have a problem before that.

I have a nuerologist (most often 2-6months)  and GP (haven't need to go).  Those are my primary docs at this point.  Have gastro and gyno (annually) and others but so rarely see them. 

My insurance situ is i think interesting and here are some insights on a income based program.  I work every day and have been employed f/t since i left college - I am now working from home 30 hours a week.  My employer does not offer health coverage. I have been working for with this employer for 6 years.  With recent events (physical) I feel very lucky to be able to work and being at home has been the lifesaver since I couldn't drive for months.  I'm grateful to still have a job. 

When I left my corporate job with health coverage in nyc, my husband was starting his own business.  When my husband left corporate world to start his own biz, Health coverage for the both of us was $1,800+ a month.  This amount is so beyond words to me - i can't even say what I think about it.  We tried to hang on to it for as long as we could, but this amount a month couldn't be maintained - we "decided" to go without.  we simply couldn't afford it.  At that point - we were not going to doctors unless it was imperative.  We've always been that way.

We moved to VT where my husband grew up. Our state has recently put in place a program - You pay based on what you earn.

I have to say we've been in a difficult situation - with my phsycial complications - i am grateful beyond belief that we have health coverage at all.  I am grateful to put it simply, everyday for the people who had the foresite to put this in place.   I can't even tell you enough how it has alleviated some stress from a situation where that is key to helping stay well.

I am a strong believer that too many people in our country can't afford health coverage - we HAVE to cover our home and our cars with insurance in case something happens - we can't cover ourselves?? it is ludicrous and makes no sense at all. 

There should be options - we i live there is private, medicare, medicaid and the program supplemented based on your income.  They don't cause issues for the other - you have what you have and it seems to work.

the current health coverage system in our country is so unbalanced. The middle guy as always is left to fend for themselves.  what do you guys think about states being the one implementing what they will do?  Who knows the communities needs better than the community?

Our own home states can maintain better control and auditing systems to help alleviate those who are only in it to take advantage and abuse an option that every person should be allowed to have. and feel it would prompt people to be more invovled in who is running their state government. Bringing the importance of government back to your home not to Washington DC.

The system in our country is not working. If you've been without and had health issues you'd know. We need alternate thinking and feel state is the way to go. 

and that's just my opinion.

1. How many doctors do you have and how often do you see each one in a year?

   I have 3. I see them once a year.

2. Do you have health insurance?  If so, how have you obtained it?  ie. through your employer, through a spouse's employer, on your own independently, through retirement benefits or through Medicare or Medicaid?

  Medicare via retirement

3. How much does your coverage cost? How much are the premiums? What is your deductible? How much are your copays and/or coinsurance? Do you have prescription coverage?

    $98/month taken out of each Soc Sec chk--JUST lost my partners ins., so I have no idea what the other answers are...yet.

4. What are the top three aspects of your health care and health insurance which you APPRECIATE the most?

     1.that I have it 2. cheap price 3. easy to use

5. What are the top three aspects of your health care and health insurance which you DISLIKE the most?

      1. The $5,000 donut hole 2. less coverage than I had through co. coverage 3. so many rules

6. What are your greatest CONCERNS when it comes to changes in how health care is provided (ie. delivered, financed, regulated)?

     That reform will not happen, that people will not make enough money to want to be docs and nurses, that the big 3 will win again and greed takes top seat//Ins Co., rich people//Big Pharma

7. What are your greatest HOPES when it comes to changes in how health care is provided?

  See above: that the little guy gets best care and drugs available.

Bonus questions:

Do you know how many legislative health reform proposals have been introduced in Congress this session (in the US only)?  Have you read any of the proposals?  If you were "ruler of the world" how would you change things?

 I do not have a number. I have only read clips. SERIOUSLY? I was asked same type of question by an atty in court once and I will give same answer: I am NOT the Ruler. I do not have access to info that the Ruler does; BUT, IF I DID---I would move heaven and hell to do the best I could for everyone and make sure we all had the best possible health care.

1. How many doctors do you have and how often do you see each one in a year?
Neurology: Dr. Generalist – 2x’s per year
Neurology: Dr. Specialist – 3 to 4 x’s per year
MRI folks – 2x’s per year
Chiropractor – 1x/month
Dentist – 2x’s/month
Family Dr. – approx 3x’s/year
Dermatologist – 3x’s/year
OB-GYN – 1x/year
Geneticist – as needed (rarely)
Physical therapist – as needed (depends on the year and how things are going with my joints)

2. Do you have health insurance? If so, how have you obtained it? ie. through your employer, through a spouse's employer, on your own independently, through retirement benefits or through Medicare or Medicaid?
Yes, I’m gratefully employed by the U.S. Government, so I have a fantastic selection of healthcare providers. Wish you all had the same choices I do! I picked Blue Cross/Blue Shield, Standard Option, family plan. I pay for supplemental dental and vision care as well.

3. How much does your coverage cost? How much are the premiums? What is your deductible? How much are your copays and/or coinsurance? Do you have prescription coverage?
I pay for coverage for my family, so the cost is high. The government pays $352.56 and I pay $164.58 bi-weekly. The annual deductible is $300 per member per calendar year or $600 per family each calendar year. I pay $20 per dr. visit, no referral required. Pharmacy benefits are more complicated. For Copaxone, I do mail-order and get 90 days for $65 (although Shared Solutions just wrote me that they are going to pick up the tab for a max of $50/month, so bye-bye co-pays, I think. WAHOO!) From a standard pharmacy, I pay 20% of the BC/BC Plan allowance. It’s 30% for brand names (this gets really pricey, especially for my dermatology drugs!) Dental is a royal pain and I’m not even sure where to go with that. There’s a max. of 45 physical/occupational therapy sessions per person, per year. Chiropractor visits are limited to 12 per year unless there’s a proven need that more are necessary. Inpatient hospital care is $200 per admission, if a preferred hospital, $400 if not. Outpatient is 15% if preferred and 30% if not-preferred.

4. What are the top three aspects of your health care and health insurance which you APPRECIATE the most?
1. I can go to any doctor I want, whenever I want.
2. Most hospitals and doctors take BC/BS
3. I can use it wherever (unlike an HMO that limits by geography).

5. What are the top three aspects of your health care and health insurance which you DISLIKE the most?
1. They won’t cover anesthesia for dental work for my children, so we’ve spent thousands on things they really should have paid for.
2. Medication gets very expensive, as do MRI co-pays
3. It’s a giant pain in the a$$ to coordinate my dental and medical coverage.

6. What are your greatest CONCERNS when it comes to changes in how health care is provided (ie. delivered, financed, regulated)?
1. Ever-rising cost of premiums and rising co-pays.
2. If I ever lose my job, I’m terrified of not getting insurance because of a pre-existing condition. I’m very worried that my little one will have trouble getting insurance because she has a diagnosis genetic syndrome (Ehlers-Danlos).
3. Good docs are harder and harder to find, especially in some areas because of malpractice insurance.

7. What are your greatest HOPES when it comes to changes in how health care is provided?
1. Wish everyone had the same choices I have
2. Denying coverage because of pre-exisiting conditions should be considered discrimination, as should dropping people’s coverage when they become ill and need it most.
3. Everyone should have access to high quality care.

Bonus questions:
Do you know how many legislative health reform proposals have been introduced in Congress this session (in the US only)? Have you read any of the proposals? If you were "ruler of the world" how would you change things?
I should know the answer to this, but it’s late and I’m sleepy :-)

Great questions! Can't wait to see what you learn.

Ivy

1. 1 GP - whenever I'm sick (once in a blue moon) 1 neuro - appointment once a year with understanding i can ring if i need to see him (never have) 1 MS nurse - went a couple of times, waste tbh, can't offer me anything!

2. I'm in the UK where we have free healthcare; the only cost is waiting lists! Had insurance thru husband's job once but they refused to cover MS so no point!

3. I am now a single parent, unable to work coz of MS so on benefits so i get prescriptions free

4. I guess that they're there if I need them and that their services are free

5. That I can only get physio once a week for 6 weeks then 6 months of nothing - that's free healthcare for you!  And that they refuse to fund complementary therapies which, if you have SPMS like me, is about all that might help

6. guess this doesn't really apply to UK

7. ditto

The problem with health insurance is that its not really about health (unless somebody is going to get all "in your face" about what you eat, how you live, what you put into your body, who you sleep with and all kinds of invasive questions,) and its not really about risk mitigation (which is really what insurance is really about, and is something that 99.99% of us, even claims adjusters, are terrible at evaluating.)

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Asking employers to pay is obviously not doing a thing for the 50 million people who have become unemployed during the latest "economic hiccup" which saw emloyees vomited out like "they" were toxic assets.

Not to mention that employers are getting pretty sick of the rate hikes, lower service and other games which the insurance companies have to pull to keep the shareholders, mutual funds, bond investment firms happy.

The insurance firms are "for profit."

If paying for medical services, like your kidney translant, open heart surgery or MS therapies, stands between them and their profits, guess what?

Your transplant, surgery or therapy will have to be denied, somehow, over some trivial bureaucratic "right of refusal".

They're in business to make money or they're out of business.

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Richard Nixon's solution with Humana and HMOs has run its course.

Nixon dead and Humana's rich but that doesn't mean it was supposed to last forever.

Trying to get people to just suck it up and stop bleeding was what led Nixon to accepting what Humana was offering in the first place.

We cant let the clock go back because that's clearly unacceptable.

He made the choice back then because the choice was that or tripping over dying and dead bodies in the streets of any town in the US and looking like he really didn't give a sh*t about US citizens. (Whether he did or not, I'll leave up to history to judge.).

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May I recommend the single-payer option used by every civilized country on the planet, except for Third World Hell-holes like North Korea, Burma/Myanmar, Iraq, Afghanistan, Bangladesh, Zimbabwe, and the United States.

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Having the most sophisticated medical system in the world doesn't mean a thing to millions like me who could die, or at least get lock-jaw, from stepping on a nail. It doesn't even have to be rusty.

US health care is for the rich. Guess what, 99% of the US population isn't rich.

1. How many doctors do you have and how often do you see each one in a year?

       I have two - although I should get more I'm tired of being a patient.  I have my PCP and my MS Neurologist (Specialist).  I see them for longer periods than my kids and about 16 times a year.

2. Do you have health insurance?  Yes.

   If so, how have you obtained it?  ie. through your employer, through a spouse's employer, on your own independently, through retirement benefits or through Medicare or Medicaid?

      For most of my life it was through my employer, then through COBRA.  Then I lost

      COBRA (forgot to pay - duh) and I had no insurance for long time.  THEN, I got so

      poor I qualified for Medcaid.  Finally, now after many years fighting an SSDI case I

      have Medicare and Medicaid combined.

3. How much does your coverage cost? $96 is deducted from my SSDI check. (And

         before y'all jump up and down about my coverage, my $1,100 SSDI check is

         my sole income on earth.

     How much are the premiums? $0, except as above.

      What is your deductible? $0.

     How much are your copays and/or coinsurance? $0

     Do you have prescription coverage?  Yes.

4. What are the top three aspects of your health care and health insurance which you APPRECIATE the most?  That I finally qualified for it since I am alone and totally unable to work outside the home.  Also, that my doctors accept the insurance and the drugs are covered.  And, no paperwork.

5. What are the top three aspects of your health care and health insurance which you DISLIKE the most?

      I cannot complain; I have had excellent care. 

6. What are your greatest CONCERNS when it comes to changes in how health care is provided (ie. delivered, financed, regulated)?

      I want doctors to decide what course of action to take, freed from the constrictions of managed care decided a treatment is "experimental" (i.e., that poor teenager who died b/c insurance company wouldn't approve a liver transplant because it was "experimental").  We need to find a way to make it available to all without making the mistakes of other countries where, e.g., you can't get routine tests for months, etc.

7. What are your greatest HOPES when it comes to changes in how health care is provided?

      Frankly, if you are speaking of federal government changing health care - I have absolutely  no hope they can do it right.

So, for obvious reasons........I'll stay away from the "bonus" question!

Bonus questions:

Do you know how many legislative health reform proposals have been introduced in Congress this session (in the US only)?  Have you read any of the proposals?  If you were "ruler of the world" how would you change things?

1. # of docs:  I have four doctors that I see anywhere between every 3 mos and yearly.  This is not counting a specialist or two that sometimes I get sent to--yikes!

2. I can't imagine how folks do it without insurance.  I get my insurance through my employer ( school district) so I feel blessed.  My husband & I were double covering me but those days are ending in October.  We just realized how much it was costing us monthly.

3. How much does your coverage cost?   This one will have to wait for exact amounts.  We get a certain amount of dollars from the state that cover all benefits and then if it costs more we pay on top of that.  Thank god it has prescription coverage.  I haven't had copays for two years, but that also changes as well.  The copays are reasonable approx 20.00.

4.  APPRECIATE the most?  1) My doctors are fabulous  2)  No filling out bills/ sending them in or worrying about getting reimbursed. 3)  When I have requested it I have been able to go out of the system for a second opinion. I am one of the lucky ones that has Group Health which is the plan that is being talked about in the news lately.  It's a co-op.

5. DISLIKE the most?  I really don't have any huge complaints.  When I was first being diagnosed it took awhile to get the MRI's, tests, etc.  I then began to learn how to use the system better so the waiting times decreased substantially.

6. CONCERNS & HOPES  :  We just need reform badly.  I really want a public option and although I don't believe it will be perfect it will be so much better than what society currently has.  If your your lucky enough to have coverage through your employee it can be fairly good.  I work with families that have no coverage, children who can't get the equipment they need etc...

Bonus questions:

Haven't read the entire proposals, but I downloaded them from your link --THANKS

Great questions--THANKS GG

You know Lisa I want to get back to my story but at the same time anwser the questions if I may;

1.  I have two doc, my regular doc, and my nuero, I see my nueo 3 times a year and my regular doc the same, and that is only because they make me.  My daugther has insurance, she is a property manager, and she has excellent insurance.

2.  My health insurance is through my employer, and so is my daugther's.  I pay for mine, hers is free.

3.  My coverage cost me 135.00 per month, I only pay for myself, and I pay for extra coverage, I pay for the max coverage my husband's insurance on his job is free for him.  But my daugther's company pays for her insurance so it was of no cost to her.  My so-pay is only $15.00 and my perscriptions for generic is $6.00 and for non-generic if $35.00.  My daugher's co -pay is $20.00 and her perscriptions generics are free and non-generics are $40.00.

4.  I have no deductable and my daugther's is $500.00 which she met when she went into ICU.

5.  I really cannot say, since I do not have much contact with them.  But they do not pay for much MS stuff such as the walk aid which I wish they did.  It is not our fault that they are not up on the new inventions.

6.  My concerns are the cost.  There are so many people who cannot pay for it now, how are they going to pay for it later.  They are treated with disdain now when they are on Medicaid now can you imagine how they are going to be treated if there is a government health insurance program.  It will be like the have and the have not, the cast system only disguised by insurance.

7.  My greatest hope is to change the way people are looked at, yea right.  I see the way that they are treated now.  We are a society that places value on what people have, and we put people in classes.  That is how we treat people, and how we look at people.  So we should tread lightly.  People with Medicad are treated very differently than someone with private insurance.  Another example: 

The office worker not being careful and not caring, had my daugther on the phone forgot to push hold, when she called to make an appointment, the recpt. said, "she can hold, she is a medicaid patient anyway, wrong, she had private insurance, but she did not realize that the phone was not on hold!  Tread lightly, look long and hard before you leap!      sherry/smomdukes