Five Reasons Why Privatizing Medicare is a Bad Idea

We now interrupt our regularly scheduled programming to bring you a wonky blog post. 

So a few people out there are suggesting that we privatize Medicare and give out vouchers for recipients to purchase their own insurance on the open market. This is such a bad idea for so many reasons, and shows that some people simply don’t understand how Medicare works. Here are my top five. . .

1. Medicare is the closest thing we have to a single payer system. Medicare covers one in seven Americans, 97 percent of those 65 and older., or 49 million Americans. In 2030, the number of Americans covered is expected to nearly double, with one out of five Americans covered.

This huge cohort of individuals provides enormous opportunities to test  new reimbursement and quality initiatives with a large cohort. In fact, Medicare is leading the country in many of these initiatives, including accountable care organizations, pay-for-performance options, DRGs for hospital reimbursement (which reimburses based on diagnosis, not on how many aspirin you get), and financial penalties for hospitals if patients with pneumonia, heart failure, or heart attacks are readmitted within 30 days. Those penalties are expanded to vascular surgeries/procedures in 2015.

… Continue Reading

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$25,000 and Counting: The Cost of an Infected Tooth

I’m  happy to report that all repercussions from the tooth saga have resolved. The only way you’d know anything occurred is  the small scar just under my jaw and the hole in my mouth where my second molar once resided.

Oh, and the pile of bills growing like mold in a petri dish.

Let’s look at the numbers, shall we?

So far, my insurance company informed me last week, we are up to $25,554.98 for the outpatient, emergency room, and inpatient care, including two CT scans, that I received in August thanks to the aberrant tooth infection that morphed into an abscess that required surgery to drain.

With the discounts the insurance company negotiated with providers, that amount fell to $22,903 (a 10.3% discount for those keeping track).

My share of the cost so far is $2,413.67. That doesn’t count any dental expenses, which are covered under my dental insurance. I estimate they total about $1,500 so far for  two visits to the dentist, three visits to the oral surgeon (including one tooth pulling under general anesthesia), and one visit to the endodontist. Oh, and my out-of-pocket cost will be at least half of that, if not more.

Thankfully, my … Continue Reading

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Tooth Saga — Week 3

When last we left each other, it was August 10 and I was waiting to hear if I’d be released from the hospital where I’d been incarcerated for 4 days receiving IV antibiotics for a dental infection-turned-cellulitis. I was, indeed, released that day.

Spent the next 4 days getting worse and experiencing the kind of pain that I last experienced 16 years ago while in labor, when I nearly broke the anesthesiologist’s arm until he got the epidural in. Only this time there was no epidural, just increasingly worthless opioids. Finally landed back in the hospital Tuesday with an abscessed jaw infection requiring surgical incision and drainage.

Can I just say how much fun the past 3 weeks have been? In 3 weeks, I’ve been on three antibiotics (oral and IV) two steroids (also oral and IV), multiple Vicodin prescriptions, dilaudid (thank god for IV dilaudid), morphine (didn’t even touch the pain), and handfuls of probiotics (got to keep that c.diff at bay). I’ve lost 7 pounds (not complaining) but I also lost all that great muscle definition from my hard work at the gym this summer.

I’ve lost more work time than I care to count, met and got … Continue Reading

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Tooth Saga—Day 4. Parole?

Sitting in the hospital room waiting with bated breath and fingers crossed for the warden (i.e., doctor) to do rounds and finally agree to break me out of here. Honestly, I’m getting out with or without his approval. Do you know how ridiculous it feels to be in an inpatient when you’re not really sick? And there are people all around me who are really, truly, seriously, sick? I mean their faces are the color of their sheets and they can’t go to the bathroom themselves and they need help eating. Here I am popping up and down, going for walks, teasing the nurses, and writing “going stir crazy” on my white board under the part that says “Patient is at High Risk For:”

I’m tired of being woken at 3 a.m., for another antibiotic or steroid infusion; tired of bad coffee; tired of fluorescent lights. And I think I’ve got Stockholm syndrome; for some reason, I keep finding myself back in bed like an invalid.

To be fair, the nurses and aides here are great. They truly are amazing and if I were really sick, I’d want to be here. My docs seem fine, although both are pretty flummoxed … Continue Reading

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Infected Tooth–The Saga Continues

For those of you who have stuck with me so far, let me update you once more. This time from the comfort of my hospital bed, an IV line in my arm, a rerun of How I Met Your Mother on the TV.

The good news is that my dinner will be delivered shortly. The reason that is good, is that I was told no food or water since about 11 a.m., when the CT scan showed a pretty nasty infection around the jaw muscle that might require surgery.

Doctor just popped in. . .we’re holding off.

The bad news is that I’m stuck here for at least another 24 hours! Oh, and can I just share once more the comment from yet another doctor about the, um, curious juxtaposition of antibiotics? (See previous blog if you’re just getting started here).

Next time, Debra, speak up! (assuming you can open your mouth, of course).

Sigh.

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Of Infected Teeth and Misplaced Compliance

I’m sitting in the emergency room at my local hospital, the victim of a tooth infection run amuck. While most people might be frustrated at the waiting and scared at the situation, I’m mostly curious.

Curious about how things are run here, what they’re doing right, what they’re not doing right. Here’s the main thing I can report: There really is no privacy in the ER. I can hear everything the staff says, the reports over the radio, and, from the vantage of my room, see everyone coming and going. I know that a 10-year-old girl with nausea and wooziness was brought in a while ago; she’d taken some NyQuil earlier in the day and had a cold. I know that about 45 minutes ago my nurse asked someone else to ask my doctor if I could have pain med (30 minutes after I first asked for the pain meds). Oh, and still no pain meds.

I liked being wheeled in my bed to the CT scan. Felt like a queen. Even kind of enjoyed the warm sensation of the contrast dye. But then, I’m a bit weird.

My husband just texted me. . .”Have you seen the CT scan?” … Continue Reading

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Why Do Rick Perry and Rick Scott (and Several Other Governors) Want to Walk Away From Free Money?

Imagine you are in the audience for the Oprah show with 49 other people. (Ok, I know it’s off the air, but bear with me on this). Oprah announces she is giving everyone in the audience a car. Not only that, but she will pay for all expenses related to the car—insurance, gas, maintenance—for three years. After that, you just need to pay for gas; she will still cover at least 90 percent of the costs into the foreseeable future. All you have to do is promise to give rides to people who don’t have cars.

 Would you turn down the car?

 Well, that’s exactly what several state governors, including those in Florida and Texas, say they will do—turn down federal funding to expand Medicaid eligibility in their states. The Medicaid expansion is part of the Affordable Care Act (ACA). It calls for states to expand coverage to most adults with incomes up to 133% of the federal poverty level (now $15,000 for a single person and $31,000 for a family of four). The federal government will cover the full cost for these additional beneficiaries for the first three years, gradually reducing its share to 90 percent by 2020. You … Continue Reading

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SCOTUS Rules! Now What?

Now that my heart rate has returned to normal and my inner health policy goddess has stopped doing back flips, I can try to put Thursday’s historic vote into perspective.

WHOO-HOO!

Oh, sorry. I guess I haven’t completely calmed down.

But my joy is tempered with fear. Fear that the Republicans will make good on their promise to repeal the law or defund it. Fear that the ruling will tilt November’s election to the Republicans, giving them the votes to throw the law out. Fear that, as I said in my earlier blog, we will return to where we were 10 years ago—which is heading off a cliff in terms of health care.< This is in no way a statement about which party should win. It is a statement about the need to continue on the path that has been set. If a political change can change hard-fought laws previously passed, what does that mean for the country? We have some serious problems to deal with beyond health care; if we can’t find a way to work together, we are doomed. Ok, enough philosophizing for one blog. Let’s get back to the Affordable Care Act (ACA). One thing I’ve read—and … Continue Reading

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SCOTUS Decision: Waiting with Bated Breath

I don’t know about you, but I am as anxious about the Supreme Court decision on the Affordable Care Act expected momentarily as I was the first time I turned the car keys over to the 16-year-old. Heck, I’ve been in Jamaica all week on vacation and was still checking the news several times a day.

Why? Because I believe that this decision–whether positive or negative for the law–will send ripples, no, waves, through the economy, the political spectrum, and millions of individual lives.

Our healthcare system is out of control. It is out of control in terms of spending, poor quality and complexity. It is out of control when the major reason for declaring personal bankruptcy in this country is the inability to pay medical bills. It is out of control when, as I read in a recent book by the Medical Director of the American Cancer Society (How We Do Harm: A Doctor Breaks Ranks About Being Sick in America) a woman walks into the emergency room at Grady hospital in Atlanta with her breast wrapped in towels in a bag; the breast that necrosed from lack of blood because the tumor that had been growing there for … Continue Reading

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