Tuesday, September 08, 2009

Wading into the Healthcare Morass

A few days ago, thousands of Facebook users posted some version of the following as their status:

“No one should die because they cannot afford health care, and no one should go broke because they get sick. If you agree, please post this as your status.”

I’ve been meaning to do a post on the whole healthcare mess anyway, but one friend pushed me to finally get around to it, and with just two basic points of his argument. The first: In Canada, often cited by proponents on both sides of the issue, it’s not as easy to get an appointment and can in fact, take an absurd amount of time; and two: In the U.S., anyone can go into an emergency room and get treatment. They cannot be turned away.

I can’t speak authoritatively to the Canadian side of the argument, though the Letters to the Editor page of the San Jose Mercury News and many other papers include testimonials from Canadians and former Canadians praising the Canadian healthcare system. There are, of course, also letters from those Canadians who prefer the U.S. healthcare system.

As to the second point, that anyone can go to an emergency room and be treated, that is true. It is also true that waits can be long. It is also true that someone still has to pay for that care. Patients without insurance will be sent the bill, and most likely for a much higher rate than the rates negotiated with the insurance companies.

As you may have read in an earlier post about our recent trip to Wyoming, Charlotte ended up in the emergency room due to altitude sickness. The frequent vomiting had led to a small esophageal tear that caused her to start vomiting blood. The hospital kindly mailed us a copy of the bill they had sent to the insurance company, in case it was denied and we had to pay out of pocket. In addition to a co-pay of $35, the charges included a $135 physician fee and $400 for the four anti-nausea pills they sent us home with. And there is also the matter of the ambulance. The Park Service sent that bill off to the insurance company and we still don’t know if it’s covered or not.

In contrast, a friend of Thomas’s was climbing Mont Blanc in France—another country whose healthcare system is continually reviled by many conservatives—when he also ended up with altitude sickness. He was taken to a hospital where they treated him right away, for the exorbitant cost of 20 euros (about $28 U.S).

I think that what a lot of people don’t understand is that those without insurance are still expected to pay. Every day newspapers carry articles on people who lost their homes or who have to choose between medication and food. Medi-Care will pick up some of the costs, but who pays for the Medi-Care itself? You do. As do the Medi-Care recipients.

From the Medi-Care website:

Medicare Premiums for 2009:

Part A: (Hospital Insurance) Premium

* Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.

* The Part A premium is $244.00 per month for people having 30-39 quarters of Medicare-covered employment.

* The Part A premium is $443.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

Part B: (Medical Insurance) Premium

$96.40 per month*

Medicare Deductible and Coinsurance Amounts for 2009:

Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2009 = $1,068) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.

For each benefit period you pay:


A total of $1,068 for a hospital stay of 1-60 days.


$267 per day for days 61-90 of a hospital stay.


$534 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).


All costs for each day beyond 150 days

Skilled Nursing Facility Coinsurance


$133.50 per day for days 21 through 100 each benefit period.

Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)


$135.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $135.00 deductible.)

Also: Except under special circumstances, you are not eligible for Medi-Care until you’re 65. Exemptions include being diagnosed with ALS (Lou Gehrig’s Disease), or if you are disabled.

NOTE: There are 35 pages of Frequently Asked Questions (FAQ) to wade through.

eHealth.com notes that “The Centers for Medicare and Medicaid Services allocates approximately $800 or more each month per Medicare recipient to pay Medicare benefits. The amount varies by geographic region on a yearly basis.”

Which means that, for a lot of people, there is still going to be extra to pay every month.

Let’s use me as an example again.

A couple of months ago, our insurance company inadvertently dropped our prescription coverage. I found this out on a Saturday. We were at the pharmacy because the auto-fill on Charlotte’s anti-seizure medication hadn’t gone through, and I didn’t notice until we were down to one dose. The insurance company very kindly gives its employees Saturdays and Sundays off, so either Charlotte would be out of medication for a couple of days, or I would pay it out-of-pocket.

“How much?” I naively asked.

$609 for a 30-day supply. $609. And that’s for the generic. Although we’re fortunate enough that we could have paid for it if absolutely necessary, I panicked. But because I take the same medication (though in my case it’s as a mood stabilizer) in a higher dose, I decided to split my pills, assuming that we would be able to straighten out the problem on Monday. How many people have to split their pills on a regular basis, just because it's medication or food?

$609 for the month. Add to this $482 (retail value) for my medications and you’re looking at almost $1,100 a month, just in prescriptions. I don’t know about you, but $13,000 a year would be a little hard to swing. Of course we could cut that down by almost half because I would drop as many of my pills as possible. After all, Charlotte has seizures. I’m just a little crazy.

This is a seriously long post, so I’ll just close with “More to come.”

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