Posted on 06/06/2002 2:40:06 PM PDT by moonman
And very little of that goes to pay for actual health care, mostly to the bloated health care bureacracy, including the insurance providers and ambulance chasers.
The "one payer" nationalized Hillery health care system is certainly no answer. That merely perpetuates the "somebody else is paying for it" attitude and shifts the entire burden on the taxpayers.
I've begun wondering how the opposite approach would work.
Truly unleash market forces by abolishing the medical insurance industry altogether!
And a person shouldn't be prohibited from buying so many beneficial meds over the counter unless he pays a doc an exorbitant fee for an office visit just for the priviledge of a cursory exam and a written prescription. For instance, imo, most pain meds should be feely available over the counter even if there are some people in society who are way too stupid to use them wisely. Screw Big Brother.
And the FDA should get off the drug companies' backs. It's inexcusable that drugs which have been safely and effectively prescribed in Europe and elsewhere around the world for decades can't pass muster here because, perhaps, no one has "gotten to" the right FDA official.
Competition in the marketplace, and not vigorish in a bureaucrat's office, as usual, is the solution for this predicament we're in vis-a-vis health care.
Did you consider dropping a dime on them?
Something is definitely WRONG with this picture. We work 7 days a week...and have no insurance. A year ago, I had to take my daughter for blood tests at a local hospital...they asked me what the name of our insurance carrier was, and I informed them that we had no insurance and that I would be paying in cash. They informed me that they didn't accept cash, checks, or creditcards....they didn't know how to...(HUH?) but, if I had a MEDICAID card, they would be more than willing to help us. I had tunnel vision, trust me. She sent me 30 miles away to have my daughter's blood drawn...but they still wouldn't take cash, check, or creditcard. They sent me a bill.
We don't want any handouts; we're more than willing to pay our own way. But, this is ridiculous.
I've tried all ways ... including a medical savings account. The trick is, no insurer wants us (previous terminal form of cancer, now 7 years remission) or my wife (current heart disease, having 2 congestive heart failures within a year).
The spouse is 8 years younger and will still be insured. We are self employed. The new premium is $670 w/a $2500 ($5k for family) deductible. We had a $7800 deductible w/the $400 premium. I called and no ability to get a higher deductible or to question the waiver....Blue Cross had purchased our plan, changed it, then absorbed it in 3 years. Now they are getting rid of what their actuarial tables say are the liabilities.
So I will put the premium I have been paying in a savings account. NOT a Medical Savings Account, because that gets taxed whenever I retire unless it is rolled over into a Long Term Care Policy (at least, I _think_ that's what it says.) Good genes and good health. They have not paid for a thing (mostly minor) in 10 years. Why give them my hard earned self-employed income when the increase in SS contributions will actually get me a higher benefit whenever I finally retire at age whatever-is-prudent.
Instead of insecure, I feel free. At the spouse's behest, I am going for an exam and going thru the motions for a new policy, but I certain I will be rejected as I saw the underwriting criteria which includes turndown if one ever had a cholestorol reading of over 220 OR ever had treatment for high cholestorol. I have the sort that isn't affected by exercise or diet and I am too well aware of the side effects of the statins to go on them....and that would render me ineligible, anyway.
There are safety nets: going into hospital via the ER; negotiating the final bill, which is done all the time and most of all, having $4800 a year to save for an eventuality. Our doc agrees the waiver was uncalled for, but Blue Cross states that External Review applications begin June 15 and the deadline for accepting their new premium is June 20th....effectively making a review moot.
No one gets out alive.
Have a friend that works in retail, a job she hates, the only reason for this job, so she and her husband can have the small healthcare insurance policy that they can afford. If I was not covered by my husband's company policy, we'd not be able to afford the cost of coverage just for me. I'd gamble and do without insurance rather than become part of a national insurance program!
For an MSA plan you might try Fortus.
There is no free lunch. Either the gov't collects your premium or the insurance company or you pay direct. On average its the same cost except the gov't has overhead and no incentive to keep costs low.
IMHO, this is the ONLY way to escape the current situation. We do have the best medicine in the world don't get me wrong. But medicine in this country has already been heavily subsidized and socialized, and along with the insurance bureaucracy and excessive lawsuits all these things have driven up the price.
Further socialization will not fix this broken system.
Based on this medical history you may be eligible for SS coverage and medicare.
An individual who becomes disabled is confronted with a host of problems beyond the physical limitations of the disability itself, not the least of which is the inability to earn a living. Because s/he is not able to work, a disabled individual must find not only another source of income, but also some form of health care coverage to pay for much-needed medical care.
Fortunately, the federal Social Security Act allows a disabled individual to receive both a monthly income benefit and health care coverage under Medicare and/or Medicaid.
A Few Basics. As we told you in the fall issue of Social Security Disability Update, the Social Security Administration (SSA) administers two income benefit programs for disabled individuals, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). The two programs use the same medical criteria to evaluate whether a person is disabled. However, different standards apply in determining whether a disabled person is eligible for SSDI or SSI (or both) and in calculating benefits under each program.
For SSDI, a disabled applicant's eligibility for the program and calculation of the monthly income benefit are based upon the applicant's prior participation in the Social Security system (i.e., working and paying Social Security taxes). Eligibility and benefit calculation for SSI, on the other hand, are based upon financial need.
A disabled person who is found eligible for either of the two main Social Security disability benefit programs will also be eligible for federal health benefits. Specifically, a disabled person found eligible to receive SSDI will automatically qualify for Medicare after s/he has received SSDI payments for two years. A disabled person found eligible to receive SSI payments will qualify for Medicaid.
More about Medicare. As you may know, Medicare has two parts - Part A, which provides hospital insurance coverage (including inpatient care and certain follow-up services), and Part B, which provides supplemental coverage for certain other medical expenses (such as physician services and certain other medical services not covered under Part A).
Eligibility. Once a disabled person has been receiving SSDI benefits for a period of 24 months, s/he will automatically qualify for both Part A and Part B of Medicare.
Cost. Coverage under Part A is free to SSDI recipients, while coverage under Part B requires payment of a small monthly premium (currently, $42.50), which is deducted from the recipient's Social Security check. Because Part B requires payment of a premium, an SSDI recipient may choose to retain Part A coverage but decline Part B coverage. However, if the recipient has a low income and few resources, s/he may be eligible to apply for state assistance in paying the Medicare Part B premium (and, in some cases, paying any out-of-pocket expenses, such as deductibles and coinsurance payments).
Enrollment. Shortly before an SSDI recipient becomes eligible for Medicare, SSA will contact the recipient and provide information that the recipient will need to enroll in Medicare. While SSA handles Medicare enrollment, another federal agency, the Health Care Financing Administration (HCFA), is responsible for administering the program. Among other things, HCFA sets the standards that health care providers must meet in order to receive payment for any Medicare-covered services that they provide. HCFA is also responsible for processing provider claims for payment. An appeal process is available for providers whose claims are denied or who are not satisfied with the amount they have been paid.
Services. While Medicare provides basic health care protection, it does not cover all medical expenses. For example, Part A does not cover long-term or custodial care or personal convenience services (such as televisions, telephones, private duty nurses or the extra cost of private rooms when not medically necessary). And Part B generally does not cover routine doctor visits (with the exception of pap smear tests and mammograms in certain instances), preventive care, or prescription drugs.
More about Medicaid. The Medicaid program is a joint effort between the federal government and the states to provide health insurance coverage for certain low-income individuals. Although each state is permitted to establish its own rules for determining who is eligible for coverage and the nature of the services that will be covered, the state's rules must fall within broad federal guidelines in order for the state to qualify for federal funding.
Eligibility. Unlike Medicare eligibility, which is based upon an individual's prior contribution to the Social Security system (through Social Security payroll taxes), Medicaid eligibility is based solely on financial need. Each state has some discretion in determining which individuals their Medicaid program will cover. However, to be eligible for federal funds, the states must provide coverage for certain groups, including disabled individuals who qualify to receive SSI payments (although, in some states, the eligibility requirements for Medicaid are more restrictive than the criteria for SSI).
Cost. Coverage under Medicaid is free to eligible recipients.
Enrollment. In most states, enrollment in Medicaid is automatic for SSI recipients. However, in some states, SSI recipients must apply for Medicaid benefits through a state agency.
Services. In order to receive federal funding, each state Medicaid program must provide certain basic services. Examples of mandatory services include inpatient and outpatient hospital care, rural health clinic services, laboratory and X-ray services, physician services, and, in some cases, home health care. States may place appropriate limits on a service based upon criteria such as medical necessity or utilization control.
In determining whether or not you are disabled under Social Security's rules, the Social Security Administration considers five questions.
Are you working? If you are and your earnings average more than $500 per month, you cannot generally be considered disabled.
Is your condition so severe that it interferes with basic work related activities?
Is your condition found on the Social Security Administration's list of "disabling impairments?" If so, you are automatically considered disabled. If not, Social Security compares your disability to those on the list to determine if it is of equal severity to a listed condition. If it is, then your claim is approved; if not, the process goes on to the next question.
Can you continue to do the work you did during the last 15 years? If the answer is yes, your claim is rejected. If the answer is no, the evaluation process goes on to ask the final question.
Can you do any other type of work, when your age, education, past work experience and transferable work skills are taken into account? If you can, no benefits are awarded. But if you can't, you will be entitled to receive disability payments
One of the best ways to cut the cost real quick would be to make more drugs available without a prescription. Whenever one of my colleagues from our office in MN is in town he makes a beeline to the nearest pharmacy to stock up on Claritin. You can buy it here OTC for about $20 Canadian ($15 for the generic version, less if they're running a special). He says that at home the price for the same quantity is $80, so with his co-pay he's out of pocket $20 US. The prescription requirement means his insurer is paying $60, plus the cost of a doctor's visit, for $10 worth of medication.
TORT REFORM
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