What do you do if you don't have medical insurance?

[Sara PA]

Marg,

In the current political atmosphere in the US the talk is about making purchasing private health insurance mandatory, not a one payer system. The goal is insurance for all, not health care for all. For those who can't afford it there are suppose to be credits to help them pay for it. But if you are barely making ends meet, forcing individuals and families to pay thousands of dollars/year for insurance doesn't solve a whole lot. For instance, women my age who have to buy private insurance are paying $8,000 - $9,000/year, if they can get it. There are an awful lot of women my age who can't afford even half that.

Which brings up another issue. Part of the discussion about this mandatory insurance is whether or not insurance companies will be allowed to turn down people whom they consider to be risks. If they are, who will cover those who high risk? A government program? If a government program can cover those who are high risk, why not those who are low risk?

Even many in the medical profession are calling for one payer health care because of the cost to them with the multi payer system, their own cost in providing their employees health insurance, simple fact that they are hogtied by the rules of the many insurance companies and their multitude of plans and the simple fact that they are becoming concerned about their need to determine treatment based on ability to pay.

But this country's deep fear of anything that the opposition is able to label "socialism" and the simple fact that no politition who hopes to be elected will risk supporting anything like that can be labeled that way, we ain't gonna get a one payer system for a very long time.

In the primary elections, two Democrats supported a one payer system -- Dennis and Mike Gravel. And both were considered to be sort of jokes. I'll be you never heard of either of them.

PS-- You really should hear some of the lies that are told about health care in countries that have one payer systems. No matter how much people in those countries say the stories simply aren't true, a lot of people continue to believe them. So while you believe your system, though it has some problems, is far superior to ours, many will never believe you....at least until they find themselves uninsured with health problems or filing for bankruptcy because of health care costs even though they have insurance.

And, fwiw, I have yet to run into someone who lives in a one payer system who would trade that for the American system.

 

[flutterbee]

Amen, Sara.

Just to add, I have serious concerns about putting our health care into the hands of for-profit companies. Just feeding us to the wolves.

 

[Stella Johnson]

Sara,
In TX there already is a high risk insurance pool for "high risk" ppl. The rates are sort of high, about $600 a mo for a middle aged woman. I have a friend that is 55 and she is on it. It is funded by all the health ins companies in TX and administrered by Blue Cross Blue Shield.
The amt she pays is less than I paid for Cobra when I was unemployed .

I have a friend from Ireland that lives here now. He always carried private ins through his employer when he was there because the socialized medicine was so poor there.

Don't forget that the countries with socialized medicine typically tax residents aroun 40% of their income. Probably about the same as they would be paying if they got their own ins.

Not to mention look at what our gvmt has done with medicare.

Donna,
How was your son injured on the job? Did he fight the enial with the state?

Steph

 

[Sara PA]

Medicare is the most cost efficient provider of medical coverage in the United States (except, of course, for it's Plan D part which is run by private insurance companies) while providing health care for virually ever person over the age of 65 (and some younger). I'd be willing to bet it's the most cost efficient for the doctors and hosptitals to process, too. What gets costly to process are all the various supplemental programs that seniors are forced to carry because Medicare provides incomplete coverage.

It is a fact that Americans pay far more for their health care (cost per person) than do the people anywhere else in the world for care that the World Health Organization ranks as 37th best*. Much of that cost is adminstrative fees for health care providers, insurance companies and employers along with the fact that we pay more for drugs than any other nation. And, of course, it includes the insurance companies' profits.

As for Texas having a high risk group, that's my point. If it's the state's job to insure those who the private insurance companies reject because they don't think they will make money on them, why shouldn't it be the state's job to insure those on whom the insurance companies are making money? A one payer system would do that more cost effectively.

*http://www.photius.com/rankings/healthranks.html

 

[Stella Johnson]

Medicare is aministered and managed by 5 different private contractors. Talk to any doctor you know. Medicare is a bigger pain to deal with than the larger ins co's.

I'm a worker's comp adjuster. I deal with- medicare an health care insurance companies daily. While health ins is a pain, medicare is a nightmare. They hire the bottom of the barrel ppl to pay them the least they can with- no education. You get what you pay for.

Have you ever talked to someone on medicare? My grandmother has constant problems getting them to pay for things they approved or getting them to approve procedures she has to have.

 

[Sara PA]

Of course I know people on Medicare. My parents, grandparents, aunt and uncles were on it, and my other aunt is still on it. None of those people EVER had a problem with Medicare. In fact, I don't think I ever heard of anyone having a problem with it. Of course, none of them opted for the privatized Medicare plans. All stayed with the traditional government run Medicare. I've heard -- and read -- a lot about problems with the privatized Medicare programs.

With a one payer system, we would eliminate the need for workman's comp, Medicare, Medicare supplemental, Medicaid, the various military dependent/veteran care programs, among other programs. People who could afford it or employers who want to lure better workers with extras could have insurance that provides extra services, but it wouldn't be needed.

Fact remains, less money is used to pay for administation and more is used to pay for health care in the Medicare program than any other health care insurance program in the country.

 

[dreamer]

well, I am gonna speak as a consumer with experience. LOL- and whether any of what I say is "right" or "worng" or whatever, it is my experiences.
My husband has been on Medicare since 1991 or so, due to disability. and he has been treated since maybe 1997ish or so primarily at VA hospitals due to 100% permanant and total combat service connected disability. While a VA hospital is NOT his fav place to be, our experience is that it is still better than being a Medicare patient at any of our local hosps. Altho some VA hosps are better and some are worse. Ours is not the very worst, it is fair to middlin, altho it is 90 mins from home. More than once husband was discharged from our local comm hospital under Medicare and immediately admitted to VA for long admissions, someetimes even into ICU. I find it some interesting our local comm hospital ER would discharge a Medicare patient from ER and the VA hospital would then admit him, when he pays nothing to be a patient at a VA hospital.....makes me seriosly wonder about the local comm hospital.
I have had my Medicare since approx 2003. I had a heckuva time finding a doctor to accept it and take care of me. I am 49. When my husband VA bens finally came in in full force, I got ChampVA, it is similar to Tricare, but it is NOT Tricare. I had better luck getting a doctor to accept my ChampVA than I did getting them to accept my Medicare. I do not have to use Medicares part D at all becuz ChampVA covers ALL our medss 100% thru medications by mail, and for medications we need immediately, they cover those at 75% at certain pharmacies.
Over the years we have had brief times of haveing various forms and types of Medicaide. SOmetimes it has been "Medicaide" soometimes "Kidcare" currently easy child gets "Moms and babies" While these are income qualifying gov ins programs, they are nearly worthless in my community. It is extremely difficult to find any doctor who will accept a patient with this coverage. My difficult child has had this for 2 years, and has not been able to get ANY healthcare thus far anywhere at all except just very basic very limited treatment in ER. She gets Medicare becuz she is considerd "disabled before age 18" and she gets soc sec dependants income continuing beyond age 18. difficult child just recived her Medicare card in mail recently, and she is gonna be 20 yrs old. easy child gets the newer "moms and babies" becuz the income guidelines for pregnant women is less restrictive than for typical Medicaide.
When I first had to stop working, ins cobra for us was gonna cost me $1500 a month to continue my employee insurance coverage. I could NOT get private pay medical coverage at all at any price for myself, or 2 of my kids, becuz of pre existing conditions, it made us "uninsureable" BUT we also could not get Medicaide becuz our income was a few dollars over the income cutoff. Yes, there was another program, at the time it was called SCHIPS or Chips here. The premiums were gonna be $600 per month for me, $500 for my difficult child and $400 for my son.and easy child did NOT qualify becuz she did not have a diagnosis of anything, so we would have had to buy privvate pay insurance on her seperately. Ironically, that coverage, schips or chips- covered my illness at a lower rate than other illnesses, neuro and psychiatric illnesses were covered at a much lesser rate, and actually made the schips or chip or whatever it was called be kinda useless. and our income could not support those premiums, much less the copays and deductibles etc.

In the 80s we had an HMO and I went years with an untreated infection due to the bizarre way our HMO ran things and refused to refer people on to get proper care.

While uninsured I have encountereed 2 seperate and opposite ways medical care providers have handled things. Some providers gave uninsured people a lower rate for services and some actually charged higher rates. Some permitted monthly payments from un or underinsured and some demanded full payment up front before even seeing the patient.
There were a couple short periods of time where we had dual coverage when husband still worked and so did I when due to the double coverage, providers would still demand I pay first and then seek reimbursement from ins, and insurance would refuse to reimburse me saying the provider has been over paid and the providers would carry a credit on my bill..money that came from MY pocket....that I was required to pay becuz my provider would not wait for ins to pay.....that would remain as a credit for long long periods of time.
My thoughts are my experiences with gov insurance have been not so great in the care I recieve for providers, becuz the providers say the gov takes far far too long to pay, and pays at such a low rate......but my personal experience with HMOs was not so good, either.
As for finding specialists? My experience with that is also not so great, I hear it is becuz of something to do with malpractice insurance etc in IL, specialist fled IL......so IL had a severe shortage of specialists and very very long waiting lines for specialists. My husband waited 2 years for a doctor to READ his petscan he got at VA. My son had an MRI - only shriners would even examine my son related to my observations and cooncerns - he was 7 yrs old before I could get any doctor to listen at all, Shriners DID the MMRI, it revealed his CP and heterotopia, but it took 2 more years after that on a neuro wait list before anyone would SEE him post that MRI. In spite of my observaations and complaints from time of his birth.
Dureing that time, I am certain and convinced it had a LOT to do with whaatever insurance we had dureing that time. I also believe the docs simply avoided treating my illness properly until I got my CHampVA coverage. It blows my mind that I can be as functional as I am today on the medication coctail I am on now, when I was a quadriplegic for so long before......I personally feel my insurance coverage put me in a position to be undertreated..and it robbed me of my career and ability to function. It turned out to be simply far too simple of a medication coctail that restored my abilities.

I cannot always keep up with conversations about "sociaized medicine" etc....I get easily cofused. I know there are major and serious problems with Medicaide how it works currently....and if THAT is what someone wants to call socialized medicine, I do not think that would be very good......
I am aware that in some countries there are restrictions of who gets what care for what, age restrictions, other health conditions taken into consideration when a decision is made on treating someonne for something, and many people might not LIKE how medical care might be rationed out....but I also think how it is now it is not good. How things work in theory, how they are presented on paper and how they REALLY work when you get down to the nitty gritty, they can all be quite different. I know money talks and bs walks......and I know there are exceptions to rules. and extenuating circumstances.....I know things do not always um.....appear as they REALLY are and you cannot judge a book by its cover.
My personal reality is I have a hard time paying my Medicare premiums, - yes, maybe they ARE lower than other peoples insurance premiums, but, the very nature of recieving Medicare implies I am on a fixed income.....(altho if I were more poor, yes, Medicaide would pay my Medicare premiums for me)
I personally get better from Medicare than my difficult child gets from Medicaide, but my easy child gets better from "moms and babies" than i get from Medicare. And SCHIps or Chips would have cost us plenty and been almost useless. and the HMO was terribly expensive and was not good for us personally.
(It was thru employer)
I continue to hope hard that someone will figure it all out and get something itnto place to help ALL persons out in this arena. If I had gotten proper medical care I would NOT have wound up permanantly and totally disabled, and could have continued to be a very productive member of society and my kids would not have wound up on Medicaide, either. ALL becuz when I had my thru my work insurance coverage, they still did not pay out properly and make medical treatment accesible to me.....
And then I was so ill, my kids had to pitch in and do MY personal care and not have me as their guidance dureing that time......

the whole thing is just broken, not right, messed up. an it needs to be changed. and families going bankrupt and loseing their homes and cars etc and all financial security and stability due to chronic or acute illness is just ......awful. My best friend died from melanoma and MS......her husband and kids were bankrupted from her massive medical bills. and she HAD emplyee insurance and they lived an honest but modest life with her and her husband working until months before her untimely and horrible death. She has been gone 3 years and husband and kids have STILL not recovered financially. It is just plain WRONG.

 

[Stella Johnson]

It couldn't replace worker's comp. Medicare will not and never will cover work injuries. Might want to do more research on it.

 

[Suz]

Okay gang. I stopped reading this thread when the responses stopped being on topic. I was looking for suggestions under our current system, not a series of diatribes.

So, thanks to all for your ideas. I will ask that this thread be locked.

Suz