MEDICARE and THE DEATH SQUAD

Medicare and the Death Squad
One Woman’s Opinion
By: Sheri de Grom

Medicare, I still hate you. I’ve more contempt for your bureaucracy and lack of empathy and understanding for the population you serve, than any other governmental agency. You did your best to kill me October, 2012. My memory of that event is located in my January 2013 archives.

Before President Obama was elected, Medicare provided doctor-ordered standardized care for almost a half century for all qualifying hospitalized patients.

President Obama changed the practice of how Medicare would provide and pay for hospital services. Obama’s administration launched an ‘efficiency’ measure that discourages hospitals from expending resources on older patients.

Hospitals are now being evaluated based on ‘spending per Medicare beneficiary.’ Hospitals that spend more than the average on any patient pays a large penalty.

President Obama has said he could cut thirty percent from what Medicare spends on a patient without doing harm. But research suggests otherwise.

Examining patients with heart failure at six California hospitals found that the hospitals giving more care saved more lives. The low-spending hospitals had higher mortality rates. That’s the opposite of what President Barack Obama’s cost-cutting program is doing.

Those of us that are forced into Medicare, along with the regular Medicare population, will never know what care we might have gotten or how much less we might have suffered if it weren’t for Obama’s cost cutting program. Rationing is invisible. Only the consequences are felt.

When Medicare started in 1965, the law forbade the federal government from interfering in treatment decisions. Doctors decided what patients needed and Medicare paid for each treatment on a fee-for-service basis. The Obama initiatives have destroyed Medicare as we’ve known it.

It’s likely some hospitals will stop accepting Medicare for payment, the same as many doctors do now.

We have ways to save Medicare for the population that needs it. The same population exists today that existed in 1965, except instead of being primarily rural, it’s primarily urban.

In my opinion, the United States is on the precipice of meeting socialized medicine face-to-face. Members of the Supreme Court don’t care because they’ll never be forced to have Medicare. The medical care of President Obama and Congress will continue to be taken care of without the aid of Medicare. Obamacare will never be a concern of any of the aforementioned either. Why are we, the tax-paying public, the victims of this dangerous game?

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About Sheri de Grom

Retired Fed/JAG, 5 yrs. on Capitol Hill. Former book buyer for B and N. Concerned citizen of military drawdown. Currently involved in mental healthcare reform, health care strategist and actively pursuing legislative change wherein dual retirees are exempt from enrolling in Medicare at their own discretion without losing tertiary healthcare benefits. Monitor and comment on Federal Register proposed legislation involving Mental Health, Veterans Affairs, Health and Human Services, Medicare and rural libraries. Licensed OSHA Inspector to include Super Fund sites. Full time caregive to Vietnam era veteran. Conceptualized, investigated possible alternatives, authored, lobbied for, and successfully implemented Title X, Section 1095 (known as the Third Party Collection Program of Federal Insurance).
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49 Responses to MEDICARE and THE DEATH SQUAD

  1. findingmyinnercourage says:

    I’ve had to become an investigator of medical fraud as some gentleman got his hands on my husband’s health insurance card in Baltimore, Maryland and racked up a bill of over $280,000.00 for open heart surgery amongst other issues. I guess the only good thing about this is being on disability I have had the time to spend a voluminous amount of hours working on this. I thought it had been resolved once they arrested him in Baltimore General but they let him go and he is back to using the id again!

    • Dawn – Oh how I wish I had posted a blog I have ready to go but just haven’t posted it while I’ve been working on the mental health blogs. Health idenity fraud is the fastest growing area of white collar crime in the United States. Tell your husband’s insurance company to verify each and every appointment your husband has and not to pay a single claim without verifying with you first. I know this is a time-consuming issue but not only is this guy using up your husband’s insurance, he’s also probably not paying any co-payment and that could send you into a entire area of what is now being called ‘medical debt fraud.’ An additional concern and probably the most important is that your husband’s medical records need to be examined by you and your husband to make sure all of the information included in your husband’s file is accurate. Say the other guy has a different blood type and your husband had to have emergency surgery or something and he was given the blood type that is listed in the record because of the other guy. We are talking real life and death issues here. It’s criminal and truly frightening. Some insurance companies have a life-time maximum they will spend on an individual and this guy could be racking up your husband’s coverage that he’ll need later. Always feel free to e-mail me if I don’t catch a comment you’ve made. Somehow I missed this comment and I have information that might have been helpful to your husband.
      My suggestion is to also ask the insurance company to issue a new insurance card for your husband with a new identification number. Medical identiy theft causes just as many problems as identity theft. If I can help, please let me know. Sheri

  2. Elyse says:

    Hi Shari,

    I’m new to your blog, and I find your position interesting.

    At 56, I’ve been sick for 40 years. My life has revolved around maintaining health insurance. What I would love to see is universal, single-payer health care coverage. That will not happen in my lifetime.

    As an “expert patient” I see the abuses first hand. (I also work in healthcare.). Doctors order tests that may or may not cause harm. Radiation? Risks of bowel perforation? Treatments that may leave the patient worse off than before.

    Obamacare is an imperfect solution created in a political vacuum. It could never be perfect because half of our legislature has made it their goal, not to improve it, but to repeal it — a goal that will not happen.

    I will be able to buy my own health insurance come January. It may not cover everything. No insurance policy does or should in my opinion. Not private insurance. Not Medicare. Because sadly, cost is an option.

    And I find that many of the folks who complain about lack of service are the same ones who think paying taxes is a burden. Me, I believe in paying the piper.

    • Elyse – I’m so sorry I didn’t catch your comment until now. I try to answer comments as they come in but yours slipped through the crack somehow.
      You are so right that Obamacare is an imperfect solution. I now know it has hindered the coverage my husband and I had and we’ll be paying more for less health care. There’s something that’s fundamentally wrong with that equation.
      I do hope that everyone that has been without insurance will be able to obtain adequate insurance within their budget. That probably sounds like a pipe dream but why bother individuals that are already content with the coverage they have?
      I sacrificed so that Tom and I would have full coverage for the remainder of our lives and with the impementation of Obamacare, we will lose much of what I’ve always paid for and we were happy with. Our country needs equality in all areas. There’s no place in politics for education, health care, religion, and many of the basics our founding fathers labored through when they signed the documents making the US free of England’s hold on us.

  3. Denise Hisey says:

    Sheri, as someone who works in healthcare I share your concern about the future of Medicare.
    I know several providers who have opted out of Medicare, or if they aren’t allowed to opt out they refer Medicare patients elsewhere. The pool of Medicare providers is shrinking, while the numbers of those dependent on Medicare is growing.

    I’ve been warned by those much more knowledgable than me that the full effects of ‘Obamacare’ will devastate small businesses and the economy. Insurance premiums have already skyrocketed once the earlier provisions went into effect.

    Supplemental insurance plans are required to follow Medicare’s guidelines for coverage, even if the supplemental plan would have paid in full as primary. It makes no sense and is detrimental to the insured’s health and well-being.

    • Denise – You summed up the Medicare issue perfectly. Today I overheard an x-ray technician tell a gentleman that Medicare would not cover the particular procedure that had been ordered for him and that he would have to pay for the procedure, in full before he could have it. Evidently the poor man had just turned 65 because his regular insurance would have covered the same procedure as full pay. I felt so bad for him. I would have paid myself if I’d had the money. I’m frightened by what I see going on.

      • Denise Hisey says:

        That’s a very sad story, Sheri.
        My guess is he just didn’t know he needed a referral from an approved provider in order for it to be covered. (ie: if a chiropractor refers for x-rays it won’t be covered, but if an MD refers, it would) So many rules to keep track of, and how would you know to ask?
        Side note: if the provider did not have him sign an ABN (advanced beneficiary notice) form, he would likely not be responsbile for the bill after all -even if they told him verbally it wouldn’t be covered. In this case the provider would be required to write off the charge.
        Either way, Medicare wins and someone else loses.

  4. gpicone says:

    It’s all about money! The rich must get richer because they are the ones who need money the most. Our society is collapsing from the shear weight of the demands of capitalism. No system is perfect in and of itself and we are now proving that.

  5. Great discussion, and not much I can add.

  6. Pingback: Medicare | David N Walker

  7. Jane Sadek says:

    I could tell SO many stories about the last three months with Medicare and Mom. They will pay for the stupidest, most asinine stuff at the drop of the hat, but the things that really make a difference – well ration the hell out of them and make it all but impossible to obtain. And here’s what worse, when you’re a Medicare patient, they make decisions for you based on the Medicare rules and completely ignore the fact that someone might be willing to pay more. You’ve got to fit into their scheme and any variation could mess up the providers relationship with Medicare.

  8. words4jp says:

    Thank you for a very informative piece. Healthcare/health insurance has always been the bane of my existence. I self insure myself and this has me very worried – apparently my plan has big changes on the horizon. They will be revealed in a few months. I fear I will be left out – with no insurance whatsoever. I suppose my parents are fortunate to no longer be alive, so they do not have to deal with Medicare.

    • Depending on your age, you should be able to continue with your current plan if all other situations remain equal. If you are entering into Medicare, you will automatically be enrolled in Part A by the government at no cost to you. Everyone is enrolled in Part A when they turn 65. Part B pays for doctor appointments and some ancillary services such as physical therapy. You have to enroll in part B at your local Social Security Office. I must tell you I’m not a legal expert on all of this – I’ve lived through many years of trial and error with my father and worked in white collar crime. With that being said, most people that have both Part A and Part B also pick up a supplement to their medicare Part B. If you did this, it would pay the co-pay to Part B. That still leaves you with no coverage for pharmacy and that’s a big ticket item for some of us. Once again, depending on age you will need to make another decision here. Part D plans have to do with pharmacy and I don’t know anything about them other than big pharmacy scares me. I don’t know if any of this helps. Once again, this is information I’ve gained by living life, reading and working within government.

  9. Your blog is always a must read for me, what I learn is invaluable. I gave you the Very Inspiring Blogger Award that you gave me, the info is on my page. Keep up the great work, I’m always excited to see a new post from you.

  10. Sheri, i’m personally ineligible for medicare but trust me, its not very different with medi-cal. There’s so much grueling red tape unkind people in the health field that you can only pray the ones you deal with have a conscience !

    • Deborah – Medicare and Medi-cal have worked from the same premise for years. The individuals that abuse the system are going to keep doing it until all monies are exhausted. It’s possible to stop the abuse of the system but when administration doesn’t care, it’s hard to convince anyone else to care. Stay well my friend.

      • Indeed Sheri, this administration is bent on destruction under the name of “Change.”

        • Deborah – I’m still waiting for one “Change” that will be good for the people of the United States. When I was answering Florence’s comment, it reminded me of all the EOB’s I used to examine that arrived at my father’s house and the envelopes weren’t opened until I made my quarterly ten day visit. Two brothers (professional men) tried to explain away any responsibility for Dad’s care – especially paperwork. I always went over the payments to see what Medicare was actually paying for before I went on to his secondary plan. It was frightening to see the number of charges that were paid for treatments Dad never received. Then of course his BC/BS would kick in and pay whatever the secondary insurance was supposed to cover. Hundreds of thousands of our seniors should not have to monitor medicare’s billing practices and what is paid in error and then follow up with long tedious phone calls. I was angry beyond words when I’d have to deal for hundreds of hours on the phone with Medicare explaining fradulant billing was going on and it was in no way related to my father’s care. To make matters worse, the contractor processing Medicare payment now aren’t sending out EOB’s, you can only access them on line. That is indeed sweeping everything under the carpet.

  11. Sheri, I’d love to come down 100% on your side with this issue. However, memory serves up the bitter truth. Medicare providers have abused and bilked the system for billions, hundreds of billions and each year since 1965 the cost of medicine rose to staggering amounts … not because the governemtn was “regulating” but because they were not. As a private citizen, it would be possible for me to open an S corporation, get a tax ID number and bill medicare for hundreds of thousands in wheelchairs, mechanical beds, tests and medicail supplies that no one every used. I could use my computer and my printer to make up false invoices, do a dummy account and set it up on line and make a handsome living through Medicare billing. The amount of Medicare fraud and the billions made from fraudulent billing, is staggering … so much so … that is we were to recoop wht has been lost there would be need for drastic measures, Crooks and third party billing could actually cover the national debt 🙂

    Like every other social system, once those bozos made any attempt to reduce over-spending, they created a situtation that was worse than before.

    Welfare reform begun with the Clintons was toted as a way of reigning in fraud and excesses in social services. All it did was turn the cloch back six decades, leaving children and families with less needed help. There was considerable welfare fraud which should have warranted more diligence in care giving. Instead, the back lash was once again over-regulating.

    What happened to “means-testing” for social security and medicare??? How is it that once again those on the bottom of the pyramid have to suffer because of fraud and neglect?? And when, dear Lord, will we ever figure out we CANNOT regulate every aspect of our citizens ???

    Sorry, but I am in no way going to swallow that Obama and his administration “caused” this … they are just the ones that messed up trying to fix what should not have been broken.

    • Florence – I’m not blaming Obama and his administration for causing the mess Medicare is in. However it is his administration’s initiatives that have destroyed the payment of fee for service. ‘That’ is the issue I’m so upset about. Neither did physicians have to coordinate care with computers before ‘Obama’s Administration’ of Medicare came into play. Under the new 30% gutting of Medicare – we see patients dying and not making it home because they are not receiving the services they should have. Medicare must be restored to its 1965 method of allowing doctors to administer medicine.

      Yes, I know all too well about fraudulent billing and how durable medical supplies is the easiest method to get rich quick in America. You know I spent 20 years working in the area of white collar crime and the last 5 of it in the medical field. It was an ugly place to be. A normal recovery month for my team was over a billion dollars and we barely touched the edge of what was going on in the area we were assigned. We worked 80 hours + a week without overtime and could have worked around the clock and still there would have been more crooks to catch. But, Medicare doesn’t want to look at the claims they pay. The reason they have to be filed so meticulously is so the governent checks are cut without a set of eyes ever seeing the transaction. Tell me, is that how you run your business. Talk to any individual that has to file claims to medicare, legitimate or otherwise and they’ll tell you that medicare claims are harder to file electronically than any other organization or business.

      Medicare and many social programs that are in a mess aren’t the fault of Obama, just like this awful war isn’t his fault. Someone else drove this bus over the cliff. What is the fault of Obama and his administration is the lack of sound judgement when they are cutting into the fabric of American’s lives. We won’t have to worry about gun control because we’ll be involved in our own civil war and we will not know who our enemy is. We cannot continue to take away from the people to make up for inability of the current administration to be a do-nothing administration.

  12. findingmyinnercourage says:

    I love love love these Blogs! Your intelligence on subjects I am so interested in is amazing to me! One very smart friend I have here! Thank you! XOXO

    • Thanks for the compliment. Much of what I’ve absorbed is from years of investigating whte collar crime. Medicare is an issue that hit’s my bottom-line (budget) and although I had to pay into it as a government employee, I never wanted or needed Medicare. Then to see others that truly need the medical care and can’t access the system sends me into a tizzy of my own. I appreciate your reading with me.

  13. As a 42 year veteran of the health insurance business, I can tell you there are always problems anytime a third party is inserted between the doctor and patient. I hated managed care when it first came out for exactly that reason. At least with insurance companies there was some degree of check in the fact that they had to compete for business. Government monopolies have no such check on their abuses of power.

    We now have high school graduates sitting in government offices with manuals on their desks telling highly trained and skilled doctors what they can and can’t do in treating patients. They not only deny services the patient needs, but they also force doctors to order unnecessary tests and procedures to fill in the blanks on their standardized forms. This is a train wreck long coming, and it’s one the combined wisdom of mankind probably can’t stop. How do you wean people from the dole (YES! Government provided health care is a DOLE!) once they get accustomed to it.

    • David – You bring up another interesting point. Often when the physician is ordering a specific procedure or orders a medication, the computer can over-ride the doctor’s decision. I’m appauled with what I see when I go into hospitals. Often times, doctors and RNs aren’t talking with certification specialist but are submitting codes to computers. This is not my idea of practicing medicine.

  14. Dace says:

    I think I understand what you are saying and I believe your folks need to talk to Canadians. We have a healthcare system that allows both. If you do not want to wait in line and have money to pay out of your pocket, you can go to private clinics. You can also get additional insurances that will cover all that.

    In a mean time, I see benefits to healthcare that provides care to all people. In this case, yes, I understand that also those who do not want to work or choose not to work, get covered and tax payers pay for that.
    I have a father in law. He has MS and had a stroke 2 years ago, and he can’t work. He gets some money every year (he gambled in Vegas and won. Winnings get paid out every year for the next 20 years). It is not enough to live on and afford healthcare but way too much to qualify for social security.

    So here is an old man, who can’t work and can’t afford all the doctors, tests, and rehab. Obama care is the only hope he has to get care that he deserves. He has worked hard all his life, paid taxes but still gets nothing.

    • Dace – What I’m saying is that those of us that have full-pay coverage should not be forced to enroll in Medicare. By enrolling in Medicare it automatically becomes the first payer and that gives them the say on a lot of medical decisions. With my federal blue cross/blue shield plan I don’t have to have a referal. I see a doctor when I want, I pick who I want to see and everyone is happy. Congress is gutting Medicare and doctors are saying no, we aren’t going to play your games. I shouldn’t have to pay out of pocket when I already have three health insurance plans that more than cover any health care my husband and I need. Everything was fine until Obamacare came along and pulled health care out from under those of us who had planned and saved all along. I believe there’s a population, such as your father, that needs Medicare and they should receive it as it was paid up until Obama came into office and gutted the program. If the ‘establishment’ would only listen to those of us who don’t want the coverage, that would roll a great deal of money back into Medicare’s budget for individuals such as your father who really needs assistance.

  15. This is SO abominable that I want to scream. I read all of your blogs, Sheri, and the ones about healthcare scare me. Of course, I don’t know the intimate details of the system, but it seems that although I will have Blue Shield because of my husband’s pension plan, Medicare metamorphoses into my primary insurance, right? That would mean then that Blue Shield won’t pick up the difference? I think that’s what you’re saying. If it is, no wonder it’s scary for ALL of us. I don’t need Medicare either because of James’ plan but it looks like I’ll be another one of “those” people who will be screwed over….

    • Gee Patti – Join the club. James’ Blue Cross/Blue Shield will become your secondary insurance when either of you turn 65 and begin to draw social security. If you elect to give up your social security, then you don’t have to enroll in Medicare. Yet, for every year you delay in enrolling in Medicare once you turn age 65, you are penalized for the years you weren’t signed up. Medicare is not user friendly in any shape or form. I keep my Federal Blue Cross/Blue Shield because if I ever drop it, I won’t be able to re-enroll in it again. Health care is in such a state of flux, we don’t have a measuring stick to have even a hing of what might happen tommorrow or next year. Your BC/BS will pay for your prescriptions and that’s a plus. They have one of the best coverage plans available. If James wants to retire early and he’s allowed to keep his insurance and self-pay, again BC/BS will provide you a safety net.

      • Sheri, I’m a bit confused. When you say you’re penalized for every year after age 65 that you don’t enroll in Medicare, do you mean that if you decide to NOT enroll by not accepting Social Security that you have to pay them outright forever OR only if you decide later to enroll?
        Also, is your secondary insurance (in our case Blue Shield) only used for prescriptions?

        • Patti – You bring up some really good questions. Say for example you elect not to draw Social Security when you turn 65, Medicare is automatically going to issue you a Medicare card. This is the Medicare Part A card and it covers a percentage of any hospital care you receive. Then your BC/BS would kick in and pay the portion that Medicare doesn’t pay. KEEP IN MIND, I’M NOT AN EXPERT IN MEDICARE LEGALIZE AND I CANNOT PROVIDE LEGAL ADVISE. Thought I’d better toss that statement in there so you know my knowledge of Medicare is coming from years of investigating white collar crime and trying to change the system.

          Your BlueCross/BlueShield (depending on how your policy is written for retireed employees) will pay for all hospital co-pays. Of course BC/BS will continue to pay for pharmacy expenditures (if that’s how your policy is written). Depending on how close to retirement your husband is will determine how quickly you need to start working with the human resource department of his firm to find out exactly what James’ retirement pkg. will include. If he works for the fed gov then it should be the same as mine and as long as he pays the premium, you’ll have the coverage.

          Now the penalty part of not signing up for Medicare – I was told that if you don’t sign up for Medicare at the time you are ‘entitled’ then a penalty is assessed if you decide to enroll later. I’d suggest you check with your closest social security office to get the exact facts on this issue.

  16. NotDownOrOut says:

    Sheri, I’m very interested in this topic but about to move so will return later to delve further. Very interesting points!

    • Cheryl – Good luck with the moving. I know it can be a real problem. I’m far behind on reading blogs and your welcome to comment here anytime or simply put it into an e-mail. Medicare has turned into a beast and heaven help us. When I was hospitalized in Oct. I was too sick to be admitted to a skilled facility so Medicare said I had to come home. Blue Cross/Blue Shield would have paid 100% for 12 more days. Yes, I’m mad – I’m really mad when we had 2 additional insurance plans that would have paid for my care and then it would have been safe for me to come home.

  17. Jack – Until President Obama was elected, those of us with insurance (because we had planned for our future) had access to excellent health care and we were covered almost 100%). With the arrival of President Obama and the seating of a liberal Supreme Court and a Congress that can’t agree on anything, our healthcare has gone down the rabbit hole (as they say). I’m one of the ones that managed my entire career around having supreme care throughout life and now it’s not worth much although I still pay for it. If congress were willing to entertain an idea based on common sense in reforming Medicare for the good, I believe the program could be saved for those that truly need it and the rest of us would be exempt. I don’t need Medicare but was forced into it and therefore it causes mayham with my other policies. Thank you for dropping in to comment. I sincerely appreciate your dropping by.

  18. Lignum Draco says:

    “Cut 30% without doing harm” – a familiar catchcry the world over.

  19. gpcox says:

    Oh, Sheri – how you speak the truth!!

  20. gdwest123 says:

    Hello Sheri I know nothing about the American healthcare system, except that if you’re ill it can cost you a lot of money. You’ve illuminated it a bit in your blog, and while of course I’m too ignorant of your system to make any comment, all I can say is I hope things improve. There are lost of problems with the UK health service too

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