by – Sheri de Grom
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
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.
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.
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?