FROM CONCEPTION TO DEATH, MEDICARE DETERMINES YOUR HEALTHCARE

Medicare – 2015
by – Sheri de Grom

The biggest and best commercial insurance companies have a brand new battle cry.

MEDICARE'S BITE OUT OF HEALTH CARE

MEDICARE’S BITE OUT OF HEALTH CARE

” IF THEY can do it, WE can do it” has become the medical industry’s standard with the enactment of The Affordable Health Care Act. [Known as Obamacare]. THEY refer to Medicare and THEY [Medicare] are out of control.

The numbers don’t seem large until you review them cumulatively. A frightening reality is that all other methods of medical payments are cutting their reimbursements to match Medicare’s payments. Medicare is accountable to no-one. Every provider everywhere is receiving less.

Many medical facilities are operating with a dangerously low profit margin and rotating temporary layoffs have become routine. This lower level of payment and fewer Medicare-approved days for a designated hospital stay has driven some facilities to close their doors forever.

Physicians and hospitals alike are receiving a single payment from commercial insurance companies per diagnosis. They started this payment system upon reviewing the cost savings of Medicare. Loss occurs when treatments and tests pile up for the provider of care. Laboratory tests, x-rays and other exploratory findings became a part of the amount allowed per doctor visit or hospitalization.

My husband and I have each experienced this single payment fallout.

Those of you who’ve followed my blog for a time know that during a surgery in 2012: I lost well over one-half of my blood, sustained permanent nerve damage to my right arm and hand resulting in chronic pain leading to Complex Regional pain Syndrome. This past week my Scleroderma became a direct link to the 2012 hospitalization. In addition, I acquired a hospital staph infection. Medicare didn’t care how sick I was. They sent me home. I was too ill for any skilled nursing facility or home health nursing agency to accept me as a patient. Yet Medicare sent me home from the hospital knowing I was without a caregiver in the home.

The code for the surgery I had allowed a minimum number of hospital days and out I went. My doctor and the hospital didn’t attempt to fight for the complications involved in a six-hour surgery that Medicare coded as one and one-half hours.

You may read of my experience here.

Tom’s admission to our local hospital on September 22, 2014, for an infection diagnosed as  cellulitis of the left foot, seemed to be the answer for receiving powerful antibiotics he could only receive in a hospital setting.

The admitting physician, an orthopedic surgeon, misdiagnosed Tom’s problem. I recognize misdiagnoses do occur but, seven subsequent medical specialists have also misdiagnosed Tom’s illness. Many of the doctors have been so arrogant I wanted to drop kick them back to medical school for a class on both ethics and another on communication skills.

A few days before Tom’s hospitalization of September 22, 2014, he had been diagnosed with psoriasis on the bottom of his feet and palms of his hands. I asked the orthopedic surgeon if this might have contributed to the infection in his left foot and he looked me straight in the eye and said, “Absolutely not.” With visible signs of outrage that I’d questioned him, I continued, “Tom has open wounds on the bottom of his feet and this is dangerous for a diabetic. It seems to me this would be a perfect place for bacteria to enter and become out of control.”

The good doctor in the long white coat, [the orthopedic surgeon] announced, “If you have all the answers, Mrs. de Grom, why did you bring your husband to me for treatment?”

I’ve asked myself that very question many times. At the time I thought I was making the correct decision.

Tom was released from the hospital with a prescription for powerful antibiotics, pain medication which would later lead to delirium and today, five months later, he’s still in so much pain he cannot walk.

I’ll blog in another post about the new path we’ve been on since Tom’s discharge from the hospital five months ago. At five months post the hospitalization for the infection in Tom’s left foot, he cannot walk on either foot. The pain is horrific and it turns me inside out to watch this man I love when he does his best to move from one place to another.

Tom worries about being even more of a burden on me. I urge him to let me know when he needs help.

A recent study in Health Services Research based on fifteen years of hospital data suggests that cuts in Medicare prices under the Affordable Care Act may slow the growth of overall Medicare spending. Many current hospital standard practices will not withstand the loss in operating capital.

The reports indicate that when Medicare tightens reins on its inpatient hospital prices, hospitals scale back overall capacity. This results in less hospital use by non-elderly patients, not just elderly patients, a senior policy researcher with Rand concluded.

Changes in Medicare prices affect our healthcare system broadly. Medicare is by far the largest payer of hospital bills in the U.S., accounting for more than thirty-percent of total hospital revenues.

A substantial majority of Medicare enrollees—roughly 87% have at least one chronic condition, and nearly half have three or more, compared to 21% and 7% of the general population, respectively. Forty-seven percent of Medicare enrollees have an activity limitation.

Medicare has announced that, “The party is over. The sort of money, where whatever you do, the more we’ll pay, and the more complicated thing you do, the more we will pay you, and the more risky thing you do, the more we will pay you – there’s a recognition now that, we aren’t doing that any longer.”

The above announcement would have cost Tom his life if his heart surgeon hadn’t bucked the Medicare rules for Tom’s emergency heart surgery June 11, 2014. However, as insult to the surgeon, Medicare pays more for three chiropractor visits than it does to a heart surgeon saving lives. I’m having a hard time accepting this fact!

At Mt. Sinai, the chair of surgery now demands his staff discuss hospice alternatives with terminally ill patients – and make an electronic note of the conversation that can be tracked. If it does not happen, he demands to know why.

The same chair of surgery also demands that patient’s with end-stage dementia not have three or four hospitalizations in the last three months of life or die in the intensive care unit. He closed his comments with, “This is a terrible experience for the patient and family and we lose far too much money.”

In my opinion, Medicare has become all too powerful. They have minimal oversight from any other governing body. Presidential appointees and their staff charge ahead making new laws within the administrative law division. The new laws have resulted in not only how little Medicare will reimburse providers of care but they are dead set on holding everyone seeking medical care hostage. THEY especially have their eyes set upon those ages sixty-five and over.

A physician in private practice, treating primarily Medicare patients can expect an average yearly income of $85,000. Take away the operating expenses of being in business, paying back student loans, attempting to maintain a middle-class standard of living and supporting a family – it’s easy to understand why doctors can’t afford to accept Medicare patients into their practice.

Medicare has taken away the health care I once thought I had securely protected and provided. Doctors must now fight bureaucracy to provide limited care. Often the medical care isn’t what the physician would choose for his/her patient.

Medicare is an agency brought about by congressional legislation in 1965 with the sole purpose of providing medical care for American citizens 65 and older. How has one agency within the government lost sight of the citizens it is to serve and protect?

In my opinion, Health and Human Services, [the agency with oversight of Medicare] must review the actions Medicare has taken within the last four years and the end results its had on the American people. It’s time for change!

Voices must be heard before change will come about.

Thank you for reading with me. I’d love to hear about your encounters with Medicare. Please share.

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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).
Aside | This entry was posted in Medical Care 2015, Medicare and tagged , , , , . Bookmark the permalink.

78 Responses to FROM CONCEPTION TO DEATH, MEDICARE DETERMINES YOUR HEALTHCARE

  1. Well now I understand Sherri why when I was looking for a Doctor closer to home, I was told by two of their Receptionists that they were both full up and not accepting new Patients, yet a younger friend was accepted as a Patient only a few days later by one of them, some Doctors don’t care today, it is all about money.

    Thanks for the information – Christian Love – Anne

    • Anne – The further I dig into what the political appointee(s) at Health and Human Services (the governing agency over Medicare & Medicaid) is forcing upon Medicare), I’m surprised we have any doctors remaining who’ll take care of patients over age 65. The Affordable Care Act patients are now starting to be under the same microscope. I will be blogging about a proposed administrative law we all need to get behind and push for the issues we believe in – such as proper pay for our positions when they treat us for more than one diagnoses. The whole situation is about to get away from us if we don’t get strong advocacy behind it. Sheri

  2. I’m not on Medicare, yet. But, I can tell you the rest of the Healthcare industry is just as messed up! Mike is an Independent contractor so we purchase our health care. own our own, through an agent. Our Blue Cross Blue Shield plan was discontinued in 2014 so we chose an new one for 2015 – at the price of $891 per month. (our mortgage is only $60 more) It is a PPO and we hoped it would keep us out of the “Obama Care” mess. Last week, my primary care doctor threw me out of her practice because even tho she accepts BCBS – she won’t accept any plan that can be purchased on the Obama Care Web Site. And mine can. My agent has sent her proof that I didn’t buy it there and that I’ve paid my premium but no dice. She won’t treat me anymore.

    The problem is, I live in a tiny town that has only has 3 doctors. It had 4 but when the 4th practice closed, it overwhelmed the other doctors and now no one is accepting new patients. Every one has to go to an EmergiCare for treatment. Since I’ve had this stupid embolism, I need a steady reliable general physician and the closest town with a doctor is at least 15 miles away and I’m hoping to find a Dr. that will take me, other wise it’s another 20 miles down the road. Mind you, I’m talking a plain old doctor, not a hospital or anything. We are a retirement town and a haven for Winter Texans. But, because of Medicare and ObamaCare – the doctors are not exactly clambering our way. I never thought I’d be in this predicament with what we are willing to pay for our policy.

    Sorry to hear things are so rough for you and Tom. I was wondering how the health care system treated you guys, especially after my debacle last week. I feel like one of those stories on 60 minutes where the person keeps saying, “How did this happen to me?”

    • Oh, how I hear your agony. What I’ve come to the conclusion on is that as long as we didn’t have to have Medicare [the government forces us to enroll in Part B to keep Tricare For Life which is an insurance that Tom earned for giving 20 years of his life to the military]. Anyway, as long as we didn’t have to have Medicare as the primary payer, doctors and other healthcare providers welcomed us with open arms as they were paid 100% of whatever was billed. Our prescriptions were also paid at 100%. I felt the 20 years I’d put in moving every 3 months or so investigating white collar crime and bringing cases to a successful prosecution, I would never have to face something like this. I still pay over $700 a month to carry my BC/BS coverage into retirement. I’ve kept the full pay plan but the government refuses to let them be our primary carrier as they’ve crammed Medicare down our throat.
      Before Medicare, my internist saw me at least every 2 months. I have 5 chronic conditions and he coordinates the care of all conditions. He’s a first rate diagnostician and I respect his opinion above any internist I’ve ever had. I’ve always liked the doctors he’s referred me out to for specialized care and all was good. Now that Medicare has lowered the hammer with all the forms that have to be filled out and the marginal pay they receive, my internist only sees me twice a year now. This scares me!
      The same was true for Tom. Because his internal organs are torn up with all the harsh psychiatric drugs, he now has a total of 9 chronic health conditions. Yet, his internist only wants to see him twice a year.
      It all has to do with the fact that Medicare does not pay our doctors enough to stay in business. I looked at an Explanation of Benefits (EOB) that came in for Tom yesterday. We have a new doctor on his team who we really like, a rheumatologist. The visit to determine Tom’s diagnosis was $524.34. However, now that Medicare has decided to bundle everything into one payment, they paid $154.50. That means none of the lab tests or xrays (at the doctor’s place of business) are covered in any direct way. The doctor also spent over an hour with Tom as his medical history is so complex.
      After Medicare paid, BC/BS only has to pay their portion as a supplemental would and that came to $51.70. This is outrageous!
      Tom’s new diagnoses is Psoriatic Arthritis and the doctor told us, “I’ll treat the arthritis but I will not treat the psoriasis.
      I don’t blame the doctor for not treating the psoriasis. He would not be paid for the 2nd diagnosis and we are on our own to find a 2nd doctor.
      Patients are being squeezed out. Federal law requires a doctor to continue to see you if h/she was seeing you before age 65. Then when you roll into Medicare, they must continue as your physician.
      It’s a travesty of justice in the worst way of what’s happened to you. I’m hearing over and over that doctors will not take Affordable Health Care Policies. Unfortunately you’ve been caught up in a fight that is not yours.
      We do not obtain any of our medical care in the city where we live. We’ve established our doctors in a large city about an hour away. It is often a hassle but it’s where the Medical School is and also the hub of all major medical in the state.
      With the unfortunate complications you ran into just this past few weeks I so wish I could be there to help you ferret out the health care you need. There’s nothing right about what happened to those of us who’ve always followed the rules and now nothing matters. When we are sick – no one wants to see us and having you go to emergency care is ridiculous considering the seriousness of your latest medical development.
      Let me know if there’s anything I can do to help.

  3. Sheri,
    The pay for primary care doctors is ridiculous, and has been for years. Sorry that you two have been through so many horrors. We are soon transitioning out of our gold standard insurance as my husband retires, so we’ll be front and center. Yikes.

    • Hi Julia, Oh yes, what a shock when we turned 65. We’d always had that gold standard you speak of. It’s brutal fighting this fight every day. All I can say is select wisely and from what everyone is telling me: stay away from anything that is part of Obamacare. Doctors are now avoiding it much the same way they are avoiding Medicare.
      I love your new avatar. You look great and ready to take on the world. Sheri

  4. Sheri, this is a gut wrenching post.Do criminals get better care? They have free room and board and I’m sure they aren’t required to pay for medical insurance, are they? If that is so, they have it made, except for being being jailed.
    I cannot believe your health system. I’d be so afraid of needing any kind of care or surgery of any kind. I’m having a hard time getting my head around how cold and unfeeling the thinking is.

    Sorry Tom is still not better. I can just cry. How much can a body take? ❤ ❤ ❤

    • Tess – I’ve often wondered myself if criminals get better medical care. Due to the goodness of a neighbors heart, he’s staying home from work today simply because he can lift Tom and place him in our car. That way, Tom doesn’t have to be on his feet. [Those feet that look as though an alligator had a good time chewing them up].
      Tom has been in this exact position since early September and each day it becomes worse. I cry along with him each time I have to dress his feet with new bandages.
      I’ve taken on the mental health care establishment and know how to fight them for the care I want for Tom and now I’m starting all over as Tom’s body falls apart piece by piece. His organs are severely damaged from all the psych medications and his immune system is shot from all the antibiotics that were pumped into him when he was in the hospital misdiagnosed with cellulitis. Now, with the psoriatic arthritis, the medication required to treat it [the main drawback is it attacks your immune system].
      And, speaking of our criminals. Our jails and prisons are so crowded, some with felony convictions are being returned to the streets because there’s no place to put them. Isn’t that a feel good story. Lot’s of love coming your way, Tess. While I’m out today I do believe I’m going to pick up one of those electric throws for Tom I hear you Bittens talking about. He’s always cold.

  5. What a nightmare.. I am in Canada and the more I learn about the health care of the US the more I am grateful to be in another country…

    • Cristy – The more I research, the more I’m learning healthcare is about the same around the world [at least in countries such as ours]. The coffers are either empty or nearly empty and other programs haven’t been put in place to take up the slack. I hear from the 60+ in Canada and they tell me the wait between appointments in Canada are unbelievably long and if surgery is needed hopefully you have the money to pay for it yourself or you’ll wait even longer. It doesn’t seem to matter if it’s socialized medicine or not, no one has the solution to providing medical care for it’s citizens.

  6. Thank you, Sheri. Yesterday I was overwhelmed and unable to comment intelligently. The health care crisis in this country must be addressed. Thank you for sharing your struggles with the system. I shared this on social media to get the message out.

    • Kitt – Oh how I understand about being overwhelmed. Some days all I can manage is to use my iPad and use stars to let others know I’m thankful they’ve stopped by and then come back later and respond to messages.
      I do hope your disability hearing went well. I know what an overwhelming experience that can be. The entire system needs a major overhaul but I’m afraid it’s not going to happen in my lifetime.
      I do plan to start hacking away at the Medicare program and am putting together a list of individuals that might like to be in on the ground floor. In the beginning it will consist of writing letters, e-mails, telephone calls, etc. Please let me know if you’re interested in joining up with us. We plan to include the issue of Medicare Disability.

  7. willowdot21 says:

    I cannot comment with any knowledge on Medicare but it sounds like our NHS it is on it’s way to hell in a hand cart.
    Sounds like if you can’t pay you perish and our NHS is bowling along in exactly the same direction.Good luck Sheri love to you and Tom. xxxx

  8. Yikes, Sheri … I fall between the cracks with everything. I have no secondary. I only have Medicare. They don’t cover this or that and what they do cover is only 80%. What happens is that I avoid doctors, am in medical debt for years and pretty much ignore all of them. Hospitals and doctors can sue me and get on line to wait for money.

    My sixties mentality has sprung into action. I don’t give a fig. When I die they can put me head first in a hole but until then … they can kiss my royal butt to get money.

    My oh my … where is Jimmy Stewart when we need him. Mr. Smith needs to go back to Washington and make this all go away 🙂

    • Florence – If the darn government would let me do it my way, I could give you part of my share of Medicare and that would fill in the 20% gap for you and we’d both be better off – but no, the gov isn’t happy unless they are causing problems for those of us who’ve worked hard all our lives. I know in my heart and soul that Tom would not be suffering right now if we still had BC/BS on first. I pay BC/BS, as if they were on first but, they don’t pay that way. They can’t. Medicare won’t let them! I don’t blame the doctors for not wanting to work for pennies when there are enough patients around with full pay insurance. Patients are even being screened to see if they have commercial company insurance or if it’s part of the Affordable Care Act. Many doctors here have stopped accepting Obamacare and when I ask them why, they tell me it’s as if the patient still had no insurance.
      In the meantime the Prez wants to open the borders and while I know your parents immigrated to this land, I also know they came here for the opportunity to work and have a better place to raise a family. They contributed to the country and the tax base. My grandfather walked from southeastern Arkansas to central Kansas so he could homestead a farm – we come from good stock, Florence. Our ancestors did not expect our government to turn on us in this manner.
      I always so appreciate your stopping by. I can go all sixties with you and you hopefully don’t think I’ve lost my marbles.

  9. There is so much to write about and I’ve not the energy. My daughter receives SSDI and has some funky form of BC/BS. I help her out to make her insurance payments. Her issues are just the tip of the iceberg. She is afraid that the Repubs will null the ACA and she’ll fall into to the Medicare system. I am afraid as well. I have good retirement benefits from civil service and good health care insurance with the same company for 25 years. I thank God every day that I had the sense to stick it out with the VA for the good benefits- otherwise I’d be up a creek with no paddle. Something has to change but, I do not think that politicians care. They are in government to serve themselves.

    • Yvonne – You are right, no one in public office cares about anyone else. I also hung onto my civil service health insurance but be aware, it automatically becomes secondary when you are 65. There’s nothing you can do to prevent it’s secondary status. I’m fighting the issue and believe me, sometimes I feel as though I might as well be banging my head against the wall. Every American receives Part A of Medicare on their 65th birthday. Part A is the part that pays toward hospital bills. You have to enroll in Part B and if you don’t do so within the specified window of time, you are penalized a specific amount for whatever time you delay.

      • Yes, I’m paying the penalty because for some reason I was more than stupid and I did not pay attention. But my insurance has paid well when Medicare paid what it would or could. I have NALC (25 years) and I’ve had lots of tests with this afib thing. I’ve not had to pay a penny thus far. But I pay $400 dollars every 3 months for Medicare.

        • Yvonne – Oh no – so many are unaware that if they don’t sign up within the appropriate window for Part B Medicare they will be penalized. I don’t agree with the process but then you already know I don’t agree with much of anything Medicare does or does not do.
          I’m like you. My federal insurance never asked a question about anything and all was good in our world and then we turned 65 and Medicare was forced upon us. What can I say?

          • Yes, but did you keep your federal insurance? Every civil service retiree that I know kept their previous insurance. What medicare does not cover the other insurance picks up.

            I understand about those folks that only have medicare. The meds alone are a nightmare and only pay for generics. Non generic Rx costs a fortune. If one has a serious illness then that person is screwed, royally!

            Most Mds now will not take Medicaid and some will not take Medicare. Our country is in a bad way and frankly I don’t see how the so called politicians know how or care to fix the insurance problem.

            • Yes, I kept my federal insurance. Like you, every retired federal employee I know kept their federal insurance because no one trusts Medicare. Although we all paid into it the entire time we worked, I have no desire for Medicare. In my case, my husband and I also have Tricare for Life because he is retired military. The catch we came up against is that to keep Tricare for Life, we have to be enrolled in Medicare Part B. It’s a real Catch 22 because since Medicare is primary and BC/BS is secondary, Tricare doesn’t have to pay anything except our deductible for pharmaceuticals. I will admit our pharmaceuticals would be out of reach if we didn’t have BC/BS and Tricare. Mine alone would have been $65,000 last year and Tom’s at a minimum 4 times as high. I pay $700/mo to keep my BC/BS but it more than pays for itself over and over.

              • Oh my goodness, you do pay a lot for insurance. $700 per month but then I hope that also covers your husband. VA continues to pay about 1/3 or so for civil service retiree which comes out of my annuity check. I thank God that I was smart enough to stick with the VA system although it was becoming more difficult in time. Too many stupid changes that made no sense at all. I have one nurse friend that is still working and the conditions are dreadful.

                My daughter has a peculiar type of arthritis. Drs are not sure what to call it except sero negative RA type or spondoarthrophy (sp) with Schrogen’s disease. Her meds run about 2k per month but with ACA the BC/BS pays most of it. She is very afraid that she’ll be pushed into Medicaid (she is 47 yrs old) and in that case I don’t know what we’ll do. I can’t keep up the cash flow. I helped pay off her home with some savings. She is on SSDI which helps some but does not meet her expenses. As I’ve written before there are others who are much worse off than my daughter. She had to give up her veterinary practice when she became too ill to work. It has been a nightmare from hell. She is divorced with no children and I thank God for that as well.

                • Yvonne – The only reason I stayed with government when Fort Ord on the central coast of California closed was because no one else could provide me with the insurance coverage I needed for Tom. Thank heavens I stayed with the government or I have no idea what kind of a terrible mess we’d be in now. My heart was trampled upon when we had to leave Monterey, CA but I knew what I had to do to protect us. I worked for the Department of Defense for 18 of the 20 I was government. One year I was under the umbrella of Coast Guard [a completely different beast] and my final year, I worked for the VA [I have no idea how you managed to work 25 years for them]. It was the most corrupt environment I’d ever worked in and the most emotionally damaging to employees that I’d ever seen. I can easily say, it was the worst year of my entire government career.
                  Thankfully my career field required retirement at 20 years. I was able to leave with full benefits at 54 and there was no looking back at the VA. I’ve done contract work but nothing for the VA. It is indeed a hostile environment to work in.

                  • Sheri, I’m glad that I am not the only one that experienced the inner turmoil at the VA. It really is like a place from hell in many ways. There are too many folks sitting in the “ivory tower” and no one is paying any real attention in Washington. Insiders get the best jobs> ifeel very sorry for the patients. And I don’t see any real changes happening.

                    To be exact I worked a total of 35 years not 25yrs. I stayed until my husband became very ill but I had already planned to throw in the towel in December of 2010. My lasrt day to actually work was May 28, 2010. I stayed for all those years because I wanted to get as much retirement for as long as I could tolerate the place. It was very difficult toward the end of my nursing career.

  10. That is frightening, Sheri. I’m a year away from Medicare and looking forward to it because of its affordability. I’m disgusted with how much I’m paying every month for my Affordable Care (I don’t qualify for a subsidy), and I still pay a fortune every time I see a doctor (copay and deductible). I avoid it. I hope Medicare solves that, but it sounds like the quality of care will fall apart. The Greeks used to drink hemlock when they passed 60. They might have been on to something.

    • Indeed, Jacqui, the Greeks may have been on to something better than Medicare. One of the things I’ve noticed with Medicare is appointments are becoming further and further apart. When our medical accounts were being paid at the 100% mark, we didn’t have to wait to be seen. Now you would think we were third world citizens plus speaking with a forked tongue. When I see how Medicare treats physicians, why should physicians feel an obligation toward Medicare patients. I know that’s not rational thinking and it’s not true for all health care professionals – but it is true for far too many.

      • This is not promising, Sheri. I am happy to pay a fair price for a fair product–my health. I wish there was a way to do that–a hybrid doctor of some sort. I don’t think it exists.

        • I hear you, Jacqui. If we asked a repairman to fix the icemaker in our refrigerator because it no longer made ice, he wouldn’t tell us, before looking at the refrigerator, that we had to be wrong because the refrigerator looked good to him.
          When I took our car in for it’s warranty check-up I knew ahead of time it would be $700 if nothing was wrong The head mechanic didn’t tell me to skip the check-up because the car was running fine. It’s a shame we can’t buy warranties on our bodies and then know they (our bodies) are covered in the event they break down. That’s the insurance for me!
          I will be blogging about a few hybrid medical care programs that have already broken away from the traditional insurance/doctor relationship. Some of them are rather fascinating.

  11. Terry says:

    I just don’t know what is going to happen to us who rely heavily on Medicare

    • Terry – Medicare has become a no win situation. Until we as citizens ban together and demand being treated differently, nothing will change. I want out from under Medicare and you need for it to improve. I see this as a fight for both of us. We both want the same thing and that is for Health and Human Services, the agency that governs Medicare, to listen to us and to be willing to make changes.

      • Terry says:

        I agree but many many have to agree and want to get involved

        • Terry – Getting involved and sticking it out is the name of the game when going after change. When we want something bad enough we’ll fight for it. I’ve found in my life that some are willing to take a challenge and work it in every way possible for a positive outcome, not only for themselves but for others. This is what makes a true advocate, one that goes the distance to bring change about.
          Advocacy is not easy, not if you are going to affect change. The more voices heard, the more likely any single subject will be heard.

  12. Reblogged this on By the Mighty Mumford and commented:
    LIKE RUSH LIMBAUGH ONCE ACCREDITTED TO HILLARY CLINTON’S HEALTHCARE PLAN…IT IS “WOMB TO THE TOMB”!

  13. NotDownOrOut says:

    I’m sad at the thought of so much suffering in just two lives much less across the country. I know Tom has the best advocate to be found in you. Nevertheless, it is wearing and wearying. I send my prayers for you to encounter more of those doctors with the will to fight the system for patients’ well-being.

    • Cheryl – It brings tears to my eyes to see you here reading and commenting. I’ve missed you and hope you are well.
      You are so right, the continuing battle for proper medical care is one of the most exhausting fights I encounter. I consider advocating and caregiving easy compared to fighting the system Medicare has thrown up along with the medical system Obamacare and Medicare has now brought into play.
      It scares me when I encounter individuals, on my daily quest, and I hear their stories and they tell me they have no idea of how to fight the system and they keep the doctors they have because they don’t know how to go about searching for a new one that might be better for them.
      I know you’ve had issues with doctors practicing brutality and not medicine. We as people of the US cannot allow this to continue.
      I’m not exactly sure how to approach the problem but one think I know for sure, the problem must be addressed or it will only worsen. Thank you so much for reading and leaving a comment. It means a lot, Cheryl.

  14. kanzensakura says:

    When my mother was in rehab in Florida, she shared a room with a woman who was barely hanging on to life, requiring constant care. She had been in a full stage nuring home but Medicare cut her loose after the allotted time so her doctor wrote orders for rehab so she could be transferred to a rehab facility for care, even though there was no chance of it. She took up time and effort of caregivers who were not equipped to care for such chronic condition. The mental anguish my mother suffered sharing the room was heartbreaking. her family either could not, would not care for her or Medicare would not allow for home care treatment. When her 120 days were up, she was booted out, this time to home. Her children knew what was going on yet, they acted like they were surprised and had made no plans for their mother’s care. They came to see her about 15 minutes a day twice a week. I was proactive with my mother’s social worker to ensure she received her care. You are being proactive and we both know how much work that entails, fighting with the system. If we don’t get in touch with law makers, officials, health care activists to do our part, then nothing will change. We can’t just sit back passively and exp0ect the system to take care of us because clearly, it will not.

    • You are absolutely right. I’m finding Medicare as difficult to fight as any of the Mental Health Care components I ever come up against. I had tools to battle the mental health components but my tools are more limited when it comes to Medicare. The primary component we must all remember, and you’ve said it brilliantly, is that EVERY PATIENT MUST HAVE AN ADVODATE. Your mother’s health would obviously have deteriorated to the point where you would have lost her if you hadn’t taken charge and moved her. And, don’t get me started on nursing homes. I have multiple posts set aside just for them and what I discovered while working as the CEO of one for barely 18 months. I wouldn’t have stayed that long but the Attorney General of NC wanted me to document more evidence. Going to work there everyday made me physically ill. I would throw up on the way to work and again on the way home. It’s positively the worst white color crime I’ve ever investigated and I wasn’t even supposed to be investigating white collar crime at the time. I’d hired in to be the CEO and trace where the money was going as corporate was losing money. More to come on that subject.
      You are so right, Medicare doesn’t care about when the 120 days are up for nursing home patients. The only hope the patients have is if they can be moved over to Medicaid for medications and then sign over their Social Security check for care. Sometimes this will keep the patient in the nursing home environment and not shove them toward the rehab facility.
      For a patient to stay in the nursing home environment they must participate in physical therapy and show progress with each appointment. If progress isn’t being made and the PT staff reports it, Medicare will cut off the patient’s time long before the 120 days is up.

      • kanzensakura says:

        And some one came in, every day to give that poor soul “OT” and/or “PT” and obviously, had been told by the doctor, one of the owners of the facility, to report progress. My mother was not eating and I complained numerous times as she was getting bland soft diet. She needed a normal diet. One day, the doctor/owner came while I was there and he heard an earful from me. And he heard it as I followed him down the hall and out to his car. That night for dinner, my mother had the first real food she had had in while. I had been stopping by various places to purchase and bring in food for her. I had also brought home grown tomatoes from VA all the way down to FL for her and made tomato sandwiches for her. She would have starved to death. My mother is now at home with her two sisters and getting the care she deserves. We always took care of our own. It was the old fashioned way. Not everyone can do that and you yourself knows how backbreaking and soul wrenching caregiving can be. You are onnabugeisha Sheri. Which all of us Bitten are.

        • I’m sure you’ve seen those charges for OT and PT on top of daily room and board plus medications are out of the realm of reality. Nursing homes are required by federal law to weigh patients and keep them within a specified range [I’ve often thought this is to prove the patients are actually being fed and not left to starve]. I would loved to have heard you going after the doctor/owner – those guys are pigs of the worst kind.
          I have a real issue with nursing home patients being required to eat meals in the dining room with other patients. How could you have an appetite if you looked around you and saw what life had to offer. I’m all for engaging conversation but seating people at required places is out-of-this-world crazy.
          I’ve also believed in taking care of my family. And, yes, being a caregiver is some of the hardest work on the face of the earth but also some of the most rewarding. I’m so happy your mother is now with her sisters and among a loving family environment. I know it was a difficult and emotionally draining trip for you to travel to FL to remove you mother from the nursing home and drive her to her sisters, but knowing you as the Bitten you are, it couldn’t happen any other way. Sending loads of love – Sheri

          • kanzensakura says:

            Love right back at you. LOL, I had hold of that DR like a pit bull with a steak. I’ll bet he didn’t thin 4’10” could be so persistent and I’m also betting he wasn’t used to someone standing up to him either.

  15. piso says:

    well done as usual, Sheri. America is in a sad state and it breaks my heart, along with your many posts about mental illness and specifically yours and Tom’s personal struggles.

  16. ksbeth says:

    i’m sorry to hear about tom and my thoughts are with you both. i haven’t dealt with medicare personally, other than on behalf of my mother, and it was nothing but a nightmare. this is a national disgrace.

    • Beth – Yes, Medicare is a national disgrace. The way we treat our elderly and our veterans should cause congress the greatest shame of all. However, I’m a firm believer that our current administration, congress and the Supreme Court have absolutely no sense of shame and care less about the American people than at anytime in history.
      Thank you for stopping in and leaving a comment.

  17. gpcox says:

    It breaks my heart each time I hear of the agony both you and Tom have experienced. Although I can relate [two separated, unrelated times that being misdiagnosed nearly cost my life], I say I know what you are going through. Doctor after doctor have let you down to the point of exasperation and rage – how you maintain your composure is beyond me.
    [I’ll email back soon – all my best to Tom.]

    • G.P. – Misdiagnosis is indeed a scary situation. You have it right when doctors don’t care and are simply there to draw a salary. Once Tom received the wrong diagnoses the following six doctors concurred and simply threw more antibiotics at him. We knew that wasn’t the answer and refused to take additional antibiotics. They weren’t helping and we told the doctors the antibiotics weren’t helping.
      The good news is that I think we have at least one new doctor now on the team. However, we still have a burning issue that must be taken care of soon or Tom could lose both feet. Trust me, that issue is at the top of my list in solving.
      We’ve been fortunate in having some of the best doctors in the world and now it seems we’ve run into a snag – but I will not give up!

  18. rabbiadar says:

    Sheri, I am so sorry for the nightmare you and Tom continue to endure. I haven’t had dealings personally with Medicare, but it’s clearly time to start writing to elected officials. Also I wonder if AARP could be persuaded to take on this issue.

    What is the best use of time for a US citizen who wants to protest this? To whom do we write? Or is there something more effective we can do?

  19. Marie Abanga says:

    Dear Sherri,

    Your post brought tears to my eyes I have no experience with medicare but I ‘ll say something, lash out whatever I have about lot of the Health (mental is my area of concern and well all other) system in that country I now call CRAZY America. In my country, and pretty much the third world over, The Big Apple is revered as the Promise Land. I and my family were excited when my brother won the DV Lottery. Ok, what happened happened. I thought it was just him, I thought it was his colour, I thought it was because he’s ended up a disabled and so got the minimum reserved for such. Today however, the more I read, the more I realize that indeed my brother was just another insignificant number to add or subtract depending on which angle you’r looking at the global picture from. I am currently reading a memoir called “Crazy: A Father’s Search Through America’s Mental Health Madness” and I am appalled to say the least. So much is about money. To think that they careless about 65+, makes it even more disgusting. I am so sorry for you and Tom’s travails, and for all the several unfortunate fellows in that country of yours. In my country, there isn’t any such medicare in the first place; no pretence there – you just gotta do whatever you can. Alas, which is better? Till death do come our way I suppose…

    • Marie – Like you, I fought the injustice of mental health care and continue to fight hard. I protected Tom with commercial health insurance so I always had a safety net but your brother and thousands of others don’t have that security.
      The frightening issue involving Medicare and Mental Health is that Medicare offers practically nothing for the mentally ill and Medicare is currently attempting to cut disability social security by 20% under an administrative law measure. People cannot afford to live on their disability amount now, they certainly will not be able to live on a 20% cut.
      Medicare does not pay for therapy and the only reason my psychiatrist still sees me for medication management (I have PTSD and panic attacks) is because I was his patient before I turned 65.
      My therapist has not received one cent since I turned 65 on Feb 2012. I’d been with her since 2008 and she had been paid at 100% until Medicare entered the equation. If I wasn’t forced into Medicare, she would still be paid at $100% by my BC/BS insurance and a secondary insurance I have. This makes absolutely no sense to me. I have to start a campaign against this injustice.

  20. Gallivanta says:

    I am sorry to hear that Tom is still in so much pain. Sadly it is often hard to find a doctor or specialist with good communication skills.

    • Gallivanta – We’ve gone beyond good communication skills. The doctors didn’t do additional testing to find out what was wrong with Tom. His feet have no skin left on them and these doctors knew the medications that had already been prescribed were not working. It was their duty by oath to find out what was wrong, yet they did not do so.
      Not only is Tom in excruciating pain but our lifestyle has been completely destroyed. Yes, Tom is often unable to partake in many activities but, often we’d go to a movie or a concert simply to have engagements out of the house. The doctors have taken this away from us and I’m now more responsible for Tom’s care than ever. I will not tolerate arrogance from physicians when they are receiving payment for medical care.

  21. The cuts in Medicare started in 2003 when Bush started transferring social service funding to to the defense budget to pay for wars in Iraq and Afghanistan. It was a big part of the reason why I had to give up my Seattle practice – and ultimately decided to move to New Zealand.

    • Dr. Bramhall – The American people have given up so much simply because the Bush administration sent us into Iraq and Afghanistan. Medicare along with many other social programs were raped beyond their limits.
      However, Medicare has become a ruthless agency with little over-sight and passing administrative laws (one after the other) and most Americans have little understanding of this process or how it’s even happening. Most individuals don’t know about it until the ruling becomes law and their benefits under Medicare are gone.
      Medicare is driving more and more doctors out of practicing medicine. I for one don’t want Medicare, but this program must be saved, as it was intended in 1965, for the millions who cannot afford other insurance. Obamacare will not help. I’m hearing thousands of stories of families not fully understanding the policies they have and showing up for appointments and knowing they need to have surgery to learn they have a $25,000 deductible. This is not insurance. The hospitals are asking for the $25,000 up front and people are going without the care they need. Obamacare offered nothing to millions of people who are in fact, in reality, still without insurance. We cannot allow this to happen to those over age 65 and dependent on Medicare.

  22. Wow. Medicare has become the Amazon of health insurance and everything I’ve learned by reading your posts scares the crap out of me.

    • Hi Patti – I know I can always count on you to read with me. I’m not sure what you mean about Medicare becoming the Amazon of health insurance. If you don’t want to answer on the blog, I’d like to hear what you are thinking even if you elect to send an e-mail. I have an Amazon blog coming up in the near future.
      Everyone needs to be more than concerned about Medicare and what’s happening to it. If you’d like to learn more, I suggest you scroll to the top and read down through the comments. The American people have much at stake when it comes to our healthcare.
      I’ve been thinking of you and wondering how you are. Sheri

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