Discussion in 'General Parenting' started by Andrea Danielle, Jul 18, 2007.

  1. Andrea Danielle

    Andrea Danielle New Member

    I saw Sicko on the weekend and wondered how true it really is about insurance and the health care system in the US but now I am looking through the topics on this board, it looks like it is true. Has anyone else seen it and how accurate is it?

  2. Pam R

    Pam R New Member

    I haven't seen the documentary, but I have experienced the health care system in the US, and it is terrible. I posted our story on the SICKO website.

    Compared to many other countries, the health care in the US is horrible. It's all about the bottom line, NOT about haelth, or care.

    Pam R.
  3. dreamer

    dreamer New Member

    I did not see Sicko, but I have had standard health insurance, HMOs, PPOs, Medicaide, Medicare and military coverage.
    I know there can be vast differences state to state even with Medicaide and medicare.
    I can say my daughter was found disabled thru social security but when we tried to extend her military coverage due to her being disabled before age 18 we were denied. And she did not automatically get Medicaide, either.
    I also know when we have tried to use our Medicaide and medicare here away from a city, in our affluent county, it was not worth the paper it was written on. Technically a public community hospital is not supposed to be able to deny care if you have Medicaide or Medicare, but-----our experience is they will play games with patients and find ways to get rid of them. A couple years ago my husband was on Medicare and wound up in local ER after a motorcycle accident, and they discharged him without doing any XRays, without cleaning any wounds, nothing, and I took him 90 mins away to a VA hospital where he was in ICU for 3 weeks.
    I know when I had no insurance, after first qualifying for social security disability and awaiting my 2 years to get my Medicare, I was reduced to no insurance for 2 years and my doctor did NOT treat me properly, and once I got Medicare and found a new doctor, well, had I found this doctor and had coverage he would accept previously, I most likely would not have been bedridden for 2 years.
    My son hurt his eye, our local hospital said it was "fine" I brought my son back 3 times...the 3rd time it was a different doctor, who said he wanted an outside consult- so after 5 days, they found his eye had ruptured, and leaked out his vitreous fluid but becuz of how old the injury was by then, it had by then destroyed his eye (scar tissue) Speculation at the university hospital where I then took him was, the docs at first hospital did not bother to LOOK at it properly, due to the Medicaide insurance.
    I know my son did not awaken from anesthesia post 9 hour eye surgery, BUT his insurance considered the procedure "day surgery" and nevermind we were 5 hours from home, and he was not awake, the hospital refused to keep him. (We stayed at Ronald McDonald House instead, as I was far too afraid to bring him all the way home- even tho I AM a nurse)
    My best friend complained of vision problems and was at the doctor monthly for 2 years before a sub doctor decided to investigate further into her complaint, bypassing her HMO and found her entire eye engulfed in melanoma, requireing the removal of her eye, too late, it had spread to all her vital organs. and she passed away after a gruesome time. And another friend on Medicaide took her 5 yr old to ER 3 times in less than 24 hours where no docs would even examine him (said 5 yr olds get tummy aches to be allowed to not go to school) . She finally drove her son to the an ER there, they found his intestine had twisted, ruptured, he died 18 months later after multiple organ failure due to the stress on his body from the intestine ruptureing.

    When I did still work, there was a short time, a period of a couple months where I worked full time but my paychecks went for health insurance entirely. I only got a pay stub on payday becuz the insurance permiums took my entire paycheck.

    After I no longer worked, (due to my disability) I looked into getting private health insurance for my family becuz our income was $20 a year too high to qualify at first for Medicaide- but- I was co nsidered "uninsurable" due to RA, Lupus and bipolar, and my oldest child was uninsurable due to bipolar and my son was uninsurable due to seizures, and cp. Noone would sell us health insurance! There was a gov program here in IL for uninsurable persons, but it was going to cost me $600 a month for mine, $500 a month for my dtr and another $500 a month for my son, and I would have to get standard private insurance for my non disabled dtr. Worse, it had high deductibles and high co pays and did not cover very well at all for psychiatric or neuro. (as if I even had the money for one of us to be covered under thhose prices?)
  4. dreamer

    dreamer New Member

    Let me add my experience as a long term care nurse. I worked in county nurseing home for 10 years. (I also worked Hospice and Alzheimers)
    It was not uncommon for us to have to send patients to the hos[ital. Ones that had had strokes or were paralyzed. They would return to our nurseing home in deplorable condition, saying that the hospital staff would not feed them, turn them etc. The paralyzed patients nurses at hospital would bring food trays, and set them on the bedtable and walk out without offering assistance.
    AT that time it was also common to send ALzheimers patients to a psychiatric unit for medication adjustments on their psychiatric medications. Sadly, the psychiatric unit had no clue what to do with these poor elderly patients.

    And do not for one minute think that just becuz a hospital discharges someone and sends them home that they are ok enough to be home. I had an aunt several states away who was wheelchair bound and blind, but she did live home alone with in home help 4 hours a day. She lived in very rural MN. She was insulin injection dependant, but needed the in home help to fill her syringes with her 3 types of insulin. She had to have abdominal surgery, and 3 days later the hospital tried hard to discharge her to HOME (alone) in spite of in home care not being set back up.
    My husband was in ICU at VA hospital at the time my son was at univ hospital for his eye surgery. The VA decided to discharge my husband, who had sepsis, and was psychotic even tho I was 5 hours away at another hospital. When I did not come to pick him up- they sent him home, in Nov (winter) in a hospital gown via cab- (90 mins away from his hospital)

    Not long ago, CNN had a story about a lady at a hospital I think in CA? SHe was in the ER and collapsed? Her husband called 911 for an ambulance becuz noone from hospital tended to her, but the dispatch said no sir, she is already AT a hospital ER. A little bit later another patient in the ER called 911 to try to summon help for the collapsed lady, but she was told the same thing. The lady died on the floor of the ER.
  5. flutterbee

    flutterbee Guest

    My cousin had brain surgery last week to remove a benign cyst that had suddenly doubled in size. She was to be in ICU for 2 days then in a step down unit for 3 days prior to discharge. Because of the demands of the insurance, she was released 42 hours after surgery. She never even made it to the step down unit. Her parents, who have no medical training whatsoever, were charged with the responsibility of waking her every 2 hours and to attempt to notice abnormal changes that would be indicative of brain swelling, etc (again, with no medical training). She was also supposed to have a speech therapist, etc, in the hospital before discharge, but of course that didn't happen. She wasn't there long enough. by the way, this was at our University Hospital.

    When I went in for my second heart cath (at a renowned hospital for heart health), I had sudden, sharp pain from the cath site. (I had hemorrhaged after the first heart cath/angio to the tune of 4-5 pints of blood.) I cried out in pain. The resident asked what was wrong. I said that it hurts. She said, "Fair enough." and walked out of the room. I had to page the nurse who called the cardiologist who said that I was fine - without seeing me - and discharged me. A few days and a CT scan later (ordered by a different doctor), turns out I did have a bleed from the cath site.
  6. Kathy813

    Kathy813 Well-Known Member Staff Member

    This is in danger of turning political but let me just say that it just stands to reason that companies that are in business to make money (insurance companies) are going to try to cut costs in order to to make the biggest profit possible. So they are not going to be working in the best interest of the consumer (us).

    People magazine has some interesting human interest stories this week on people who were denied insurance coverage when they needed it the most. One company quickly changed their minds on covering the Cochlear implants for a little girl when the dad let them know that Michael Moore was interested in their case for his movie.

  7. I currently work as a mediator and rehabilitation coordinator in my state's Workers' Compensation system. I deal with insurance companies and adjusters on a daily basis. My observation, for what is is worth, is that profit is the bottom line - always. Without our oversight I shudder to think exactly how many of these adjusters would treat the catastrophically injured workers with whom I work. Unfortunately in the world of regular health insurance, there is little to no oversight. I constantly observe adjusters and their attorneys work to delay and stall needed treatment for injured workers in the hopes that they will die and prevent a huge cost for "lifetime" care. Or, they will lowball a settlement of a case and tell the poor (often unrepresented worker) that is the best they're going to get - so they might as well go ahead and take the money. Even worse, are claimant's attorneys who are just looking at a quick 25% portion of a settlement and encourage injured workers to take a lower settlement than they will truly need to manage their future health care. This is a HUGE problem, because Medicaid and Medicare will not cover treatment for Workers' Compensation injuries - and so folks are potentially left with no rememedy whatsoever. My colleagues and I try our best to educate and inform the folks we work with, but so many never come to us with questions. I personally believe that the only answer is to seperate health care from profit all together. I don't have the answer for how to do that, and I'm probably talking myself out of a job. But, as long as profit is a motive, people will receive substandard care.
  8. Stella Johnson

    Stella Johnson Active Member

    While I agree we have our problems in America. Insurance companies are not charities they are in the business to make a profit. So it is true that the bottom line does matter to them.

    I have also found that it depends on what codes and how your doctor files it with your insurance company.

    But... looking at the care in Canada I think we are still better. It can take months if not years to get treatment of any kind in Canada. Yes, everyone there has insurance but if it takes you 3 months to see a cancer doctor what's the point?

  9. Sara PA

    Sara PA New Member

    The American health care system is a disgrace and very few are criticizing how Moore protrays it in "Sicko". The criticisms are more of how he went about the Cuba thing, how good the Cuba health system is (do you see a pattern here?) and that he didn't present "the other side". There is very little defense of the system. Businesses want out of providing health care because it simply costs too much in both time and money, increasing the cost of American products and services. Hospitals and many doctors want the system changed because it's complex, expensive and fragmented with too many medical decisions being made by insurance companies. And many of us without insurance or who have bad insurance or who spend way too much to get it just want health care when we need it. Many doctors will not treat patients who don't have insurance or who have Medicaid (the state based programs for low income people).

    On another board I post to, there are a lot of non-USAns. Most were surprised at how bad the US system is and not one would trade what they have for what we have. They find it appalling that even under Medicare, seniors pay $1062/year in premiums, more if they have drug coverage and both come with deductibles and co-pay. They couldn't believe that many seniors pay an additional $2,000-$3,000 for insurance to supplement Medicare. They can't get over how many people even with insurance end up bankrupted because of medical costs.
  10. hearts and roses

    hearts and roses Mind Reader

    I think if you see the movie, you can draw your own conclusions based both on what Moore presents as well as what you've experienced. It is an informative movie. I like the way Moore presents his docu-dramas because he always manages to inject a little human error and basic humor throughout. It isn't like watching CNN or C-SPAN, which would have me passed out in about a minute.

    There are some people who hate Moore with a passion, yet have never even seen one of his movies. Because he deals with controversial issues, there will always be a portion of the population who will dislike his views.

    However, if we all go in with an open mind, take what resonates with us and perhaps learn a little something in the process, I think it's well worth the $8.50/$9.00 to see this movie.
  11. Ohio

    Ohio New Member

    I have not seen the movie Sicko, as of yet. I just wanted to explain a little bit about Medicare.

    Medicare Part A: Inpatient or Hospital Visits, usually paid for while you are working.

    Medicare Part B: Optional Outpatient Medical Insurance. Premium is a little over $90.00 a month.

    Medicare Part C: The freedom to choose plans outside of original Medicare. You can choose an insurance policy with another company for slightly more than you would pay for Medicare Part B, and cover up the gaps of Original Medicare. Many independent insurance companies offer drug coverage in their plans.

    Medicare Part D: Drug Benefits.

    Medicare is governed by a strict set of laws. All doctors who accept Medicare, and all insurance companies that provide Medicare plans must adhere to Medicare's guidelines. If someone doesn't abide by Medicare rules, and guidelines, then they are in for some trouble. Fortunately, some insurance companies offer plans that help to cover the gap of Medicare. Some Medicare plans are certainly lacking, but Medicare Reform is something that needs to be addressed by legislators.
  12. Debbie MA

    Debbie MA New Member

    The healthcare system in this country is broken. We are ranked #37 in the world according to the World Health Organization but we spend more money on health care than any other country. More than 50 million people in this country are without health insurance that provides even basic care. Forgive me for my ultra-liberal-Massachusetts-Democratic views but I firmly believe healthcare to be a basic human right (along with food and shelter) and it is disgraceful that a wealthy country such as ours cannot provide that to all citizens.

    I don’t know the solution to the problem but I think that, as a country, we need to consider the following:

    Most people rely on their employer for health insurance. Some employers provide great health benefits while others provide few or none. I have pretty good health insurance but there are people who work just as hard, or harder, than I do who have very poor or no coverage. Why is health care dependent on employment anyway? There would probably be more entrepreneurs and thriving small businesses in this country if health care tied to employment were not a consideration in career/work decisions. Wouldn’t that be great?

    Many employers are cutting back on what they provide because of rising costs. More of the cost is being shifted to employees. Many people drop their employer sponsored plans when the cost becomes onerous. The working poor generally don’t qualify for Medicaid and so have no insurance at all. Some people are willing and able and want to work but don’t work because they fear losing health benefits. There’s something seriously wrong with that.

    A job loss because of a layoff or serious illness will result in loss of coverage. Many (most? I don’t know the statistics) cases of bankruptcy in this country are the result of medical debt. I don’t think that many people realize that they are one serious illness away from unemployment/loss of health insurance/bankruptcy.

    Many people do not even qualify to purchase health insurance because of “pre-existing” conditions or certain, necessary, care is precluded.

    Why is health care so expensive in this country and why do we spend more money than other countries but are only #37? Some blame the unhealthy lifestyle of many Americans and an aging population. Others point to the high price of new medical devices and technology and the cost of developing new medications. Some want to lay the blame on lawsuits against health care providers.

    I think a lot of our health care dollars are being diverted to the insurance industry and to administrative costs related to insurance. Years ago I worked in IT for a company that provided computerized billing systems to hospitals. That company eventually went out of business for many reasons but a big one, I think, was the difficulty in providing software that could accommodate all insurers, public and private, in different states, with different and constantly changing requirements. Bills that were accepted one month would be rejected the next month because of format or data requirements or ICD9 coding requirements that had been changed with no notification. I remember re-programming and reproducing bills about 6 times in one month before they were accepted by one provider. The billing office also needed to add and massage certain patient data several times before a claim would be paid. I doubt things have changed much. How much money could be saved by eliminating the middleman (insurance companies)? Could money saved cover the currently uninsured?

    As I said, I don’t know what the solution is to the health care problem in this country (although I have some ideas) but the system is definitely not working for many people. How long will it be before only the very wealthy can afford to purchase health insurance? I don’t see our “leaders” making headway on this issue at all. The last serious attempt, by the Clintons in the 90’s, was an utter failure. I hope that Michael Moore’s movie provides enough outrage among ordinary people that the issue gets serious attention.
  13. hearts and roses

    hearts and roses Mind Reader

    I am outraged Debbie. My H is outraged, my friends and family are all outraged. But it takes more than 25 people to make a change. But we try. We write letters, sign petitions and try to make a difference with our vote. We know we're not alone and that there are others out there who are outraged as well. But in the meantime, we have to follow the rules so we don't lose what little coverages we have.

    I have what is touted as one of the best health insurance policies that UHC/Oxford has to offer. Well, I can say that if this is the best they have to offer, I shutter to think of what their worst policy is like. My monthly premium for a family of 4 is roughly $1360 a month, of which I pay 20%...(I believe that due to increases, our employer will change that to 30% in April 2008). My co-pays are $25 per office visit and the co-pays for RX ranges between $15-$40 each script depending on it's status on the insurers 'preferred drug list'. I am on 3 medications and difficult child is on 2 medications, and easy child is on 1 medication. Altogether our RX copays equal $150 per month, difficult child goes to a counselor 5 times a month and usually the regular FP, which equals roughly another $125-$150 per month in DR visits. Heaven forbid my back should go out and I need to see my chiro, usually 3X in one week usually for two weeks, and since my insurance won't accept her as a DR on their network, I pay cash out of pocket at $35 a visit! So add another $210 per adds up very quickly. difficult child is also supposed to see the chiro at least twice a month for fibromyalgia, but doesn't because I simply cannot afford all the freakin copays. Each month my medical bills could range between $275-$500+ out of pocket ON TOP of my regular premium contribution of $272.

    The insurance companies are in bed with the pharmaceutical companies and together they are lobbying our government to get what they want all around. It's a corrupt business. Like you said, it's not that far fetched to imagine a day when the only people who have access to decent medical care and coverages will be the very rich. And then, what will happen to those of us who are asthmatics, diabetics, mentally ill, terminally ill, and suffering from life long debilitating diseases and infections?

    As you also said, the conditions of health care coverages in the US is outrageous and more people should be doing something about it. Learning about it, reading about it, and then doing something about it.
  14. TerryJ2

    TerryJ2 Well-Known Member

    I'm glad I saw this. I've been meaning to see that movie.
  15. MedicDVG

    MedicDVG New Member

    Just when you go to the movie, remember that Michael Moore is NOT a documentary film maker who is objective, fair, or even remotely balanced. He is there to make something sensational that will make him money. While he may make a good movie, don't take his view of things to be gospel.

    Now, having said that, the US healthcare system is heading for an implosion and collapse sooner then later. I have worked in healthcare my entire adult life and I have seen first hand what the system does to people. Note I said 'to' people, not 'for' people. The only people the insurance companies are 'for' is their shareholders.