MEDICARE – RELIC OF A BYGONE ERA

Medicare/Medical 2015
by – Sheri de Grom

Have you tried to ask Medicare a simple question lately?

Have you tried to ask Medicare a simple question lately?

Medicare was created by Congress in 1965 under Title XVIII of the Social Security Act to provide health insurance for people aged 65 and older, regardless of income or medical history. Before Medicare, only half of older adults had health insurance, with coverage often unavailable or unaffordable for the other half.

Previous to 1965, older adults had half as much income as younger people, and paid nearly three times as much for private health insurance. Medicare was needed at its onset.

Medicare’s implementation of a one-size-fits-all program seemed a logical first step. Individuals without health care suddenly had access to physicians and necessary services.

Initially Medicare consisted exclusively of Part A which covered 80% of hospital and other inpatient cost. Part B was also initiated and it covered 80% of physician visits and other medically necessary services.

Today, the 80% coverage has been eliminated and all rates are negotiated with the Centers for Medicare and Medicaid Services (CMS), a component of the Department of Health and Human Services (HHS). The rates are not negotiated with physicians or other health care professionals that provide patient care but are decided upon by bureaucrats with no medical background.

In my opinion, it requires more than an MBA in accounting to successfully manage a program such as Health and Human Services and community service experience to manage the Centers for Medicare and Medicaid Services! These individuals are Presidential appointees.

The negotiated rates Medicare and Medicaid are demanding of each diagnosis makes it impossible for doctors to earn a satisfactory living treating Medicare patients. It’s no wonder these doctors who once opened us with welcoming arms no longer want to see us. We have become a deficit on their balance sheet.

The Medicare patient is still required to enroll in a Part D program, which partially covers

Part D is for partial prescription coverage.

Part D is for partial prescription coverage.

their medications unless they have a private insurance program. It’s not unusual to find senior citizens living on a fixed income dividing limited resources between medications, food, utilities and other necessities in their home – if they even have a home. This is one of the problems that sends elderly women to the streets where they join the thousands of homeless men and younger women and children already in the homeless population.

Citizens of the United States have a wide range of medical needs that can no longer exist under Medicare’s original intent. Every day 10,000 baby boomers join Medicare.

Like most of my fellow boomers, I continued working full-time after I’d retired from my career. I survived by paying the maximum into Medicare just as I paid higher income taxes.

We pay the maximum for Medicare Part B as required by law. This frequently happens when you have a second career after leaving behind a career wherein benefits begin at the end of 20 years regardless of your age. [That’s what happened to me. My career choice with the federal government required retirement at 20 years regardless of age. I was 54.] After what we’ve already paid into Medicare, not counting the $700/month for BC/BS plus dental & glasses insurance, Medicare is a scam of the worst kind.

Vietnam Wall, Washington D.C.

Vietnam Wall, Washington D.C.

What’s more troubling, Medicare is an assault on every retired military member and their families. Unless we enroll in and pay for Medicare Part B, our rights to Tricare for Life is taken away.

At the time soldiers were drafted and/or volunteered for Vietnam plus every conflict and war since then, the promise of free medical care for life for themselves and their families was guaranteed. This free medical care wasn’t of the VA variety but medical care in the civilian community upon a minimum 20 years service to their country.

David N. Walker @davidnwalker.com reminded me recently that there are only two people willing to give their lives for us: Jesus Christ and the American Soldier.

Tricare for Life is not an add-on-bonus for the soldier at the end of his career. A portion of his salary each month is allotted for Tricare. We can’t call that medical care free, can we? Now, the Pentagon and Congress require soldiers and family members sign up and pay for Medicare Part B making Medicare the main payer and then Tricare for Life the secondary payer.

My government is denying me freedom in the marketplace and I don’t like it. Tom and I have already paid in enough to Medicare to own a second home along the central coast of California [Big Sur, Carmel by the Sea, Monterey] and a third home on the Outer Banks of North Carolina.

Take Our Medicare Money and Give What Healthcare It Would Buy to Someone Else!

Take Our Medicare Money and Give What Healthcare It Would Buy to Someone Else!

Our medical expenses would be covered 100% without Medicare. Why is Medicare pushed at us when our nation is in serious financial crisis? My husband and I would be happy to give our share to someone who needs what we’ve paid. We’re far from wealthy but we’d be better off if Medicare would go away.

Medicare has made a shamble out of healthcare. It dictates what doctors must document and do to such a degree that they don’t have enough time for the patient in front of them.

If you are receiving care and are swallowed into the Medicare system, have you noticed your doctor handing you a sheet of paper or even multiple sheets to read? The information may be as basic as your hair may grow thinner as you age but nevertheless, your physician must educate you in order to check off another box to qualify for the maximum Medicare payment.

I want my doctor(s) to work for me. I consider my internist the single most important part of my health care team. Call me old-fashioned, but I believe my internist’s core obligation is to be honest with me about my medical risks and thoughtful about how I manage them.

It makes no sense that my physician is worth less to Medicare than he was before I turned 65 and was forced into Medicare.

The Affordable Care Act is rapidly changing the way Medicare is paying claims. One of the largest and one that has kept me away from blogging is the critical care I’ve been faced with in caregiving for my husband, Tom.

You may remember, in my blog of Nov. 21, 2014, I announced I was taking a much-needed blogging break and would be caring for myself until after Christmas. You may read that blog here.

Later I’ll write about how I almost lost Tom, and due to receiving the worst healthcare possible (governed by Medicare) he’s been in excruciating pain since mid-September. His pain is 24/7 and when he is forced out of bed for an appointment, he’s confined to a wheelchair [this would not have happened except for the gutted healthcare system we are caught up in].

Tom’s situation started with a physician’s incorrect diagnosis and we were further exploited by a second physician who had a God complex. It was during this 7-month odyssey that I learned a physician with a Medical Board Specialty would not treat a second diagnosis directly related to and in the same location of a more serious diagnosis. The physician may have more knowledge he can/will share with a patient and help them make more informed decisions. If the specialist extends care beyond his specialty, Medicare will reduce their payment in the form of a fine. Additionally, the patient is forced to find another specialist to address the second symptom related to the more serious diagnosis. In addition, the doctor would be using allotted time for another patient with an appointment. Doctors no longer have an extra cushion built into their schedule to allow for such events. This payment regulation makes no sense to me.

Tom was recently diagnosed with psoriatic arthritis and the rheumatologist made it clear that he would treat the arthritis but not the psoriasis.

This 7-month journey of obtaining the best health care for Tom continues in an exhausting form. There seems little time for much else these days. I will lay out all the facts of Tom’s care over the past 7-months. I’ve kept my journal during this painful journey and I’ve discovered new fields of medicine, doctors who sabotage the works of colleagues, the dangers of misdiagnoses and fear of other doctors unwilling to confront their peers’ mistakes as well as the continuing stigma we meet along life’s way. Once I sort out the mountain of paperwork, I’ll attempt to put the past months into a bulleted format.

I apologize for not visiting your blogs on a regular basis. I continue to appreciate your support. I’ve had days when I wanted to do nothing more than to stare into space but Tom’s needs have doubled. His not being able to walk has changed our lives on so many additional levels.

How about you, have you learned anything new about the state of our health care since we talked last?

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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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66 Responses to MEDICARE – RELIC OF A BYGONE ERA

  1. Sending warm thoughts to you and Tom. Yeah, laying in one hospital dying from an embolism, full of more insurance than god, and it takes 3 hours to convince medflight to come get me and move me to a hospital who have the meds to save my life.
    Now, if I’d been in a gun fight while selling drugs on the street corner, they’d be tripping over themselves to transport me to kingdom come and save my life.
    But, little old honest me – evidently my life is worth a crap!

    • Yes, I understand you completely. I’ve seen this very thing over and over. We’ve even had the situation wherein we had the medical flight ordered by our congressman, the helicopter was at the hospital and ready to transport Tom and the hospital refused to release him. What’s happened to those of us who planned for the day when we knew we’d need insurance and then – now that day has arrived and it doesn’t mean a thing that we’ve been responsible and everyone else seems to be getting all the care. Something is seriously wrong with this picture and I don’t like it any more than you do.

  2. Every psychiatrist I have ever seen has refused Medicare and has asked me to sign a release indicating that I understood as much. Finally, I refused Medicare insurance and got on my husband’s plan. For awhile I had two policies, one a Medicare Advantage Plan administered by Anthem Blue Cross, the other an Anthem Blue Cross plan through my husband’s employer, the City of Long Beach (with many employees). Both policies refused paying all my claims, then all my husband’s claims. It was a nightmare, with no one, including the California Insurance Commission and my husband’s Human Resources department, assisting us. We kept fighting until the problem was solved, and I refused Medicare Part B in writing. I still have Part A for hospitalization, so should I be hospitalized… Luckily, hospital claims departments seem to be more sophisticated than private practictioner’s staff.

    • Kitt – For those that need Mental Health Care there’s no coverage when it comes to Medicare. I had 100% coverage for all of my mental health appointments until I turned 65 and then I suddenly had zero coverage. My therapist has continued to see me since Feb 1, 2012 when I turned 65 and we finally managed to get $750 out of BC/BS after 2 years of fighting. It was my BC/BS that finally paid that small amount and since then, they’ve paid nothing.
      It took almost 2 years to get an opt-out letter with Medicare before BC/BS would consider her claims. Now, BC/BS is playing some game of their own but they are responsible for the claims she submits and now I have to figure out what that is. I pay over $700 for that insurance out of my retirement and by golly, I plan to make them pay!
      Additionally, I don’t have the name of the law and the citation, [I’ll look for it again] but your psychiatrist cannot legally make you sign the documents stating you know Medicare will not pay him. If I remember correctly, NAMI legal played a big part in passing this legislation. Psychiatrist used it to make patients pay but it’s not legal.
      There’s several other laws that are pending and I’ve wanted to write about them but Tom has been so sick, my time has been really limited.
      Hang in there and I’ll try to get some information up in 2 weeks or so about the work-around. Although Obama promised Parity with mental health, we all know it’s not there and never has been.

  3. I want to weep. Every time the government gets involved in anything, you can be sure it will be a mess. I’ve see U.S. movies which involve people going to hospital and I couldn’t accept what people have to pay for tests or what they are allowed to have and not not have. Your story sounds even more deplorable. It almost boils down to working and paying for medical bills and doctors before house, home, food etc. It’s inhuman who Tom has had to suffer and the idea that you need to go to another doctor because the primary one cannot extent care beyond his specialty. Boggles the mind.

    • Tess – Indeed, it does boggle the mind. Just yesterday I received the Explanation of Benefits (EOB) from BC/BS in the mail for Tom’s first visit to the rheumatologist. I was appalled. It’s no wonder Medicare doesn’t have the nerve to send us an EOB. I can’t remember the last time they bothered to notify us of the amount they paid. It’s no wonder citizens of the United States believe doctors are getting rich! This is the doctor who finally diagnosed Tom correctly after 7 months of our not knowing what was going on and being tossed about in a storm of never ending frustration. Tom spent a little over 2 1/2 hours with this doctor. Nothing was paid by Medicare for the diagnostic pathology completed [laboratory testing and x-rays]. These tests were necessary to determine exactly where Tom fit into the spectrum of the disease for a treatment plan. The part that really threw me was the office visit was billed at $132.90 and they paid $53.71. There’s a 21% cut coming down the pike on April 1 if congress doesn’t stop it from happening. What will our doctors do then? Rheumatologist are in short supply in the U.S. I don’t see things improving anytime in the near future.
      Thanks for stopping by to read with me and as always, for commenting.

      • Instead of making progress we appear to be regressing across so many levels of our lives here as well.

        • Tess, I wanted to catch up on reading my favorite blogs of yours. How soon are you cutting off comments on your blogs. I know my comments are not earth shattering but I so love reading your work. You are full of insight and your flash fiction is among the best I read. I shared several with a group at a local coffee gathering at the hospital lately. Everyone was really impressed. Now I need to get them to ordering your books. Do you have a new one coming out soon? I’ve been missing you. Hugs, Sheri

          • Aren’t you a dear? I had cut off comments for March Break because I unplugged for the week. I’m doing a guest post soon which I will re-blog to my site. They are the earlier flash fiction I cut my teeth on a couple years ago.
            I tried for an anthology close to my heart recently, but got turned down because it wasn’t memoir they wanted but fiction. I didn’t see that specified anywhere. I must keep trying.
            The latest I’ve had published are last summer’s anthology publications compiled by Russ Towne. Sigh.
            Hope you are well? Can you put your feet up a bit this weekend? Get outside to the garden? ❤ ❤

  4. Sheri, sorry to hear of the horrible situation you are facing and what has happened as you caught us up on it all. Your sharing here is going to help people who are struggling so it’s good you continue to do so!

    • Hi Christy – Thanks for stopping in. I’ve been researching Concierge Medicine and hope to have a blog on it in the next week or so. If we were just starting out in our quest for quality health care and considering companies are dumping health care as a benefit, I think I’d probably go with Concierge Medicine. The patient would have to do due diligence in selecting the right primary care doctor for themselves and their families, but packaged right, the more I read and research, the more I like what the model has to offer. It seems a win-win for patients and physicians alike. Of course, we’re bound to find problems as more and more doctors sign up to practice concierge medicine, but I would give it a whirl with a back-up for pharmaceuticals and high-cost coverage.

  5. Lignum Draco says:

    Sheri, what a horrible situation you and Tom are in. Your medicare system sounds like a shambles, and it has directly affected Tom. Is there anyone of power/responsibility you can take your case to?
    This sounds like a complete mess.

    • Lignum – You are so right. Medicare is in shambles yet they won’t cut us lose. I always love Tom’s story about responsibility as it relates to government. I should use it as a blog some day. In essence, when he joined the military and was leaving for his first assignment, his COL handed him an envelope with papers inside and told him to hand it to the first responsible person he met when he reached his new duty station. I’ve heard Tom tell the story many times but love to hear it each time it comes up because it says so much about government. He tells he approached several different individuals in different capacities and levels of importance, asking them, “Are you responsible?” No one would say they were responsible. When Tom retired from the military, he still had the envelope with the folded papers inside.
      Our government has become so troublesome and the parties will not work together. Therefore it’s impossible to pass legislation to benefit the people.
      I’ve been researching Concierge Medicine as I mentioned to Christy above. I plan to post a blog regarding Concierge Medicine in the near future. The more I read about it, the more I like the entire concept.

  6. Whenever the government gets involved, the red tape starts a cycle of paperwork and expensive bean counters. Can’t we just keep it simple?? You are indeed a cherished voice Sheri!

    • Renee – Our bean counters are so full of self-importance they forget what promises they made to the people while on the campaign trail. Others have been in office so long, they’ve forgotten there’s any other way of life. I was always amazed, the years i worked on the Hill, how many days there was literally no one ‘minding the store.’ Congressman seem to show up when it’s convenient for them to do so.

  7. Vic – Sometimes that seems the hardest part, taking the time to take care of myself. I find myself falling into bed later and later with so many tasks left undone. I’m learning bit by bit that it doesn’t really matter if the house is perfect, etc. There are some things I simply have to let go. I’m looking forward to spring when I can be out of doors and be in the gardens.
    I hope things are going smoothly at your house. Sheri

  8. willowdot21 says:

    Sheri I am always appalled by the short comings of the medical services. I am in awe of you and I do hope you have plenty of support from friends and family. I hope you have time to yourself occasionally to recharge your batteries.
    I agree that Drs will not step out of their specialism to see the broader picture. Also I know you can get shoved from pillar to post trying to get a diagnosis! I really believe that it is all to do with fear of being sued that had made them too cautious!
    I recently followed my husbands example and left a really bad GP practice where they only let you speak to a Dr on the phone,who often made a diagnosis over the phone ( Goodness they must be clever and have xray eyes!) The new practice is much better and you can see a Dr and they do really seem to care about you!
    Back to you Sheri I am thinking of you and praying that you and Tom will get through this horrendous time. xxxxx

    • I’m beginning to think healthcare is the same worldwide. There seems to be so much tossing of patients about. Tom and I have zero family but we’ve managed all this time with just us. We do have another couple that’s very dear to us and I have long distance friends who I talk on the phone with when time permits. I do believe I finally have some of the medical issues straightened out again but we’re far from home free.
      I’m delighted you found a new practice. That makes all the difference in the world.
      Thanks for stopping by to read with me.

  9. Sheri – you’ve done it again. Your work is important. The comments you receive are golden. Blessings to you and Tom. Pizzo

  10. This retirement age is a lot more frightening than I thought it would be. I have psoriatic arthritis too-like Tom–and a wonderful rheumatologist. I’ve already checked that he takes Medicare, so I’m somewhat relieved. But, I fear he’ll retire.

    I’m on Blue Shield right now, costing about $22,000 a year–more than my house payment. There was no choice. I should go on Medicare in a year and see that as a huge savings, but maybe the price of saving money will be too high in medical care.

    The whole thing scares me to death.

    • Jacqui – You have every right to be scared. I’m delighted to know you have a wonderful rheumatologist. One of the main things I stress about doctors and Medicare is that as you near the age of entering Medicare, make sure your doctors all accept Medicare (which you’ve already done) and I try to guess that they will be practicing medicine in the same location as long as I live. (Of course there’s never a sure fire way of knowing this). When you do go on Medicare, have you thought about what you would use for your supplemental policy or do you plan to pick up the co-payments yourself? Then there’s the medications. It really is a terrible mess.
      Some like Medicare HMOs but I’m afraid of them. The worst year of medical care Tom and I ever had was under a BC/BS HMO and I spent a fortune out-of-pocket.
      As always, thanks for reading with me and leaving a comment. Sheri

  11. Someone please tell me what service of any kind has improved once the government stuck its nose in.

    • David, you are spot on. Nothing has improved and it’s getting worse by the day. It’s maddening when I know excellent medical care is available and it’s a phone call away. It’s Medicare that keeps us from being able to reach two physicians that are the tops in their field and Tom would not be going through the medical crisis we’re faced with at the present time.
      It troubles me greatly to have the knowledge and I pray for all. I know many don’t have the advocacy knowledge I have and feel I must keep pushing ahead for not only Tom and myself but for every American.
      I so appreciate your stopping in to read with me and leaving a comment. I’m trying to get back into a routine of blogging and visiting my blogging friends once again. I’ve more than had my hands full with Tom’s new illness.

  12. ksbeth says:

    once again, you have described a broken system, in succinct terms and with great emotional feeling. i’m sorry that things have become even more challenging for you and tom recently, and know my thoughts are with you.

    • Beth – You are such a sweetheart to keep cheering us on when I can’t remember the last time I visited your ‘house’ and I always have such a good time there. Thank you for sticking with me. Yes, healthcare took many wrong turns with Tom in the past 7 months and it’s been more stressful than ever (and I didn’t think that was possible). However, hopefully I’ll be able to share some of what we went through and what I learned in the process and it’ll provide knowledge for you and others and the same will not happen to you and others that read my blog. Sheri

  13. gpcox says:

    I really don’t know what to say to this article. Just when you think you’ve seen the limit of what a country can do to their veterans – they pull something else!!
    [Sorry I haven’t emailed – been real busy here – I’ll get to it shortly.]

    • G.P. Thanks for reading and commenting. Don’t worry about the e-mail. You know how I get buried for months at a time with e-mail. My carrier took it upon themselves to erase 50,000 messages without my permission so perhaps it’s best you hadn’t written. Needless to say, I hadn’t been keeping up but I had been scanning and erasing as time permitted. I know I had smoke coming out of my ears as it is a paid account. You might try writing to sdegrom19@gmail and see how we get along there. Take care of yourself, my friend.
      If you talk or hear from veterans directly could you please help get the word out that the VA is trying to convince veterans they could get help faster if they went to the outside for medical care (if they are 65) and use their Medicare. Of course what the VA is not telling them is they more than likely will not get an appointment faster plus it will cost them the co-pay and they will have to pay out of pocket for any medications they may need.
      Many of our veterans have never used civilian care and need an advocate to help navigate through the maze of healthcare as we know it today.

      • gpcox says:

        I know how confusing health care ins. can be [and I’m basically healthy] – The maze of paperwork for veterans must be astronomical!! I’ll give that new address a try shortly! All my best to Tom and YOU take care of yourself!

        • G.P. – Thankfully we don’t have to rely on the VA for Tom’s healthcare. One of the reasons I accepted the transfer from Monterey to DC when Fort Ord closed was to keep my Federal health insurance. I knew with Tom’s health issues, insurance would be our most important item as the years went by. It doesn’t matter how much money anyone throws at you, without insurance, it didn’t mean anything. The only doc we have at the VA is the #1 doc Tom has and that’s his psychiatrist and he is pure gold. He is the reason we cannot move to the west coast!

  14. Your posts are always so informative and factual, educating me on parts of the U.S. health system. Even though I cannot truly relate to it, my husband is American so he is aware of how any changes effect his friends and family in the U.S. So far, he has been impressed with our healthcare system, considering it is virtually free, except for dental and medications (which would require a plan to cover). I wish the U.S. could adapt a similar system. (Anyone who says they have, is very misinformed). My mother cannot afford much needed dental work, has no plan and this is my biggest issue at the moment. It is unacceptable to me that there is no affordable dental care plan for a 76 year old widowed woman living solely on her government Old Age Pension. I cannot imagine having to deal with the worry of her paying for medical care.
    I am so sorry for the frustration you must feel when you just want to focus on your husband’s health…and yours. Keep writing…it’s a good release!! (((hugs))) to you.

    • Thank you for reading and commenting. I’m not sure what country you are in. Several of my blogging friends are in countries with socialized medicine and their countries are running out of money for healthcare and real problems are occurring. You are so right about dental care being one of the biggest problems with US Healthcare and it always has been. Tom and I have relatively good coverage for $60/month and our vision plan is the best I’ve ever seen and it’s only $20/month. Medicare cannot mess with either of these two great plans because they don’t offer the service.
      I don’t want socialized medicine in any form. What the Affordable Care Act has done is allocate tax payer’s money so that many can now have insurance. I see no difference in this approach than Medicaid and truthfully resent my tax dollars going to provide someone health insurance when there are other means to cover our national health care issues. Obama thought he could cover a big problem but he’s only made it worse. I’ll be blogging about a few of those problems that are now exploding in the near future. I always appreciate your dropping by to read and comment.

      • Sorry, Sheri. I neglected to say I am in Canada.

        • Not a problem at all. We have friends in Canada and often hear about their trials with healthcare. I’m beginning to believe individuals with age-related chronic conditions are the ones with the most difficulty accessing the health care they need.

          • Hmm..I am interested in what types of conditions they have had difficulties with. Overall, I am very happy with our health care. I feel very fortunate.
            My mother suffered from arthritis and has had 2 knee replacements by an excellent surgeon. No charge. Wait times for nursing homes are very long. That is a big issue. As far as access, I am intrigued.

            • Please excuse my delay in getting back to you. I took a couple days away from my own blog to read and comment on others. It seems to be individuals with long term chronic illnesses that have the hardest time getting appointments and follow-up appointments. I know of cases involving heart disease, diabetes, and a gallbladder removal where it took too long to schedule the surgery and the gallbladder burst and the patient later died from sepsis. I believe both systems have huge problems that must be addressed immediately or they will fail all citizens.

  15. M-R says:

    Deeply disturbing, Sheri. Our current pack of morons laughingly called ‘the government’ is trying its best to create something similar …

  16. Well, Sheri, you write the way it is and I’ve written before the government is screwing the little people. I have a horrible feeling that one day our country if not the world is going to fall apart and there will be no hope for tomorrow. I sound like a doomsday person but honestly that is the way I see things. There is so much corruption in the government and it seems to be getting worse.

    I’m so sorry that your husband now has another disease. Both of you are in my prayers.

    • Yvonne, Hello and how are you, my friend. You’ve been in my thoughts and prayers as Tom and I have been searching for medical care for the latest develops causing him such pain 24/7. I’ve been away from blogging and my friends, and that includes you, dear one. It seems all I do is chase one doctor after another and then fire them when they turn out to be more selfish with their time and I’ve learned more by doing research on line than they’ve bothered to share with me. The issue that infuriates me the most is when one doctor will not share with us all that he knows about what he’s supposedly treating at the moment. I refuse to accept this as the answer to today’s healthcare!

      • Dear Sheri, I so hope and pray that eventually you’ll find good doctor for your husband. It will not be easy. From my daughter’s experience with Mds for her arthritis it is like living a nightmare and the process remains on\-going. Having an awful condition leads from one thing to another. You are never free from finding new answers. I empathize with you and especially Tom. Diet change might help. Even holistic medicine could play a part in helping with the pain as well as other alternative treatments and meds.

        • Yvonne – I’ve been a vegetarian for almost 40 years and I grew up on a black Angus cattle ranch. Dad never used growth hormones or other nasty stuff like so many cattlemen do today. I’m slowly moving Tom over to vegetarian and all organic. I’ve also been investigating some alternatives for treatment in bringing relief. It seems we find relief in one arena and here comes something else.
          Because the psoriac arthritis settled in his feet, it’s far too painful to walk and therefore is in a wheelchair. That is definitely the hardest part for me as I have chronic nerve pain in my right hand and arm. I normally don’t take anything for the pain but most nights, I don’t have a choice. I either have to take something or I lay in bed and my whole rt side throbs.
          I do hope you are doing as well as possible. You continue in my prayers and I think of you often. With love, Sheri

  17. Hi, Sheri … so sorry to hear more bad news for you and Tom. The dire situation with our entire health care system becomes worse by the day. There is no way out of the maze of red tape and misinformation. I learn more each day about how my medical needs are never going to be met by Medicare. I urge anyone who is still young enough to plan, to do so.

    We have missed you around here. Please hang in their. You at least give people the amunition they need … knowledge 🙂

    • Florence – Thank you my friend for sticking with me. You are so right in that our medical needs are never going to be met by Medicare. I know it seems impossible, but if a working 20 something could put away 40% of their salary from this day forward, they might have a shot at getting the health care they need beginning around age 70. Of course, those numbers are based on having lived a life of eating right, exercise, controlled stress, and all the other problems that crop up and weigh us down before age 70.

  18. shoe1000 says:

    Sheri
    Have we allowed the system to discount all forms of life except those that benefit themselves? We are imploding when those who served cannot get the benefit of their bargain. To me this is another tiny example of how the super minority are benefiting while those who created the infrastructure and sense of safety that created that sense of security are losing more and more of those things that make life safe and comfortable.
    I am sad you are going through the hell that you and Tom are.
    Warmly
    Jim

    • Jim – You hit it exactly right. Eisenhower was the last president who cared about the American soldier. Others have given lip service but none have made a difference in the lives of those who serve or their families.
      I’d planned so carefully for Tom and I to have excellent health care coverage for life. I knew my choices were limited as Tom had pre-existing conditions and therefore I made the best of what career choices presented and worked hard to get as high as fast as possible. . . all to protect the two of us after I retired. All of my planning for healthcare worked brilliantly until we each turned 65 and the leaches came out and took away what was rightfully ours.
      I used to hope we could make change happen with a new election but I know that won’t happen. We are no longer a government by the people and for the people.
      As a side note: you may be aware that while Sens. Grassley and Brown presented a bill that would prevent the Centers for Medicare and Medicaid Services from implementing rules putting restrictions on antipsychotics, anticepressants, anticonvulsants, antineoplastics, antiretrovirals, and immunosuppressants.
      More frighting, through the administrative law process (the Federal Register) Medicare is attempting to push through the same rule they proposed just last year before it was pulled. I blogged on this subject under the title, MEDICARE PART D HAS ME WORRIED. If you would like to do some advocacy on behalf of mental health, these issues need help. I wish I had all of the links with me. If you are interested, I’ll gather them up and get them to you before the blog I hope to do about advocacy. I also need to check the date when the Federal Register Comments are to close. Sincerely, Sheri

  19. I signed up for Part A Medicare 2 years ago when I turned 65. I only have it for my occasional visits (every 2-3 years) to the US. For routine medical needs, I’m extremely lucky to enjoy the low cost medical care offered through the New Zealand National Health Service.

    • Dr. Bramhall – Thanks for reading and commenting. I always look forward to hearing your ‘take’ on the direction our healthcare is going. I’m sure you’re aware Medicare Part A only pays for in-patient and related charges. I’m interested in knowing how responsive the New Zealand National Health Service is when treating chronic conditions that are expensive over several years (20 or more). I’m thrilled the New Zealand Health Service meets your needs. Do they cover pharmaceuticals and all ancillary medicals such as x-rays, diagnostic labs, etc.?

  20. Terry says:

    I can’t even describe better than excellent of how I feel about this post. I am unfortunately one of those people who are being sucked into the program. Not only do I live on limited funds, I receive SSDI based on what I earned throughout my life, which is shit, because I was a stay at home mom for the most part. I wanted to raise my kids not let a baby sitter do it. I still have to pay a premium here in my state to have the extra insurance for appointments and medications. I still have to pay too much for my medicines. I am running out of money and if it weren’t for my daughter I will or would be in the streets in less than a year

    • Terry, You are a loving and giving mother, sister and friend. You’ve given to others all your life and now is the time for them to love you in return. When I realized my father didn’t have enough to live on or take his medication as he was supposed to, I considered it my responsibility to step to the plate and put as many safety nets in place for my father as I could. Dad had always been my John Wayne and had sacrificed so much for us kids. My brothers more or less walked away from him after our mother died and then turned around and stole the ranch from him. They said put him in an old folks home. My father was active and used to horseback riding and going and doing everyday. He was a working rancher and had no idea what to do with himself. My mother would be so ashamed of the boys she raised.
      What I’m trying to say is that Dad was proud and didn’t want to accept what Tom and I offered so we did it discreetly at first. His Social Security check was a little less than $300 because President Roosevelt had said put all of your money into land and not social security. Well, since my brothers got the land, that left dad with nothing. Tom didn’t hesitate one moment when I asked if we could buy Dad a house in the small town where he knew everyone and he’d gone to high school. Without going into details here, we were able to give Dad a home of his own, a comfortable life where he didn’t have to worry about money, he knew he always had an open ticket to fly wherever we were living and he normally stayed 3 weeks or so and he traveled with me all over the world. Terry, accept your daughter’s grace. I’m thanking her in my heart and in my prayers for loving and providing for her mother. She’s living the heart her Mother taught her all those years ago when her Mother (you) elected to stay home and raise her instead of leaving her with one babysitter after another. With love, Sheri

  21. Wow, Sheri. Have I learned anything new about our healthcare system? Uh, yeah, I have. In a synopsized form: after my daughter left residential care she had to have a Discharge Plan, right? So, we are going to enter her into a program that teaches her DBT therapy which her psychiatrist wants her to do BUT the insurance company doesn’t “contract” with that group to pay the $2800 dollars. They’d rather send her to an outpatient program for which they paid over $100,000 last year. That program says she should go into the $2800 program because she’s finished with their program. But, the insurance would rather shell out thousands upon thousands of extra dollars because they’re “contracted” with the more expensive place.
    WHAT?

    • Patti – Oh how I hear your frustration. I wish I could tell you this is the first time you’ll have this crazy thing happen to you, but it’s not. NOTHING MAKES SENSE. It never ceases to amaze me how insurance companies refuse to bend a rule for the sake of a contract. Of course all the flags of corruption go up for me but on the other hand, these are private companies. They can be reported but often that’s not the best course of action when you have a family member caught in the middle thus the same thing happens to other patients over and over. This particular abuse of patients is particularly rampant in the mental health arena of insurance.
      Often times you’ll find the ‘contracted place’ is actually owned by the insurance company. You might check on that and then if they do own the program they say they will pay for, I would appeal their decision about not sending your daughter to the program the discharge planning committee approved the best for her recovery. I would push the issue that the insurance company should be eager to have your daughter try the less costly of the two programs on the chance that it will save them money on future hospitalizations. Just a thought.

  22. Just Plain Ol' Vic says:

    The most important thing is for you to take care of your husband and yourself!

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