May 21, 2011 2:58 PM

So Daria -- did you track the charges made to Medicare and to your mother's private insurer?? And if there were discrepancies did you complain to the Physician's office, Medicare service line and insurance company claim management dept?? I ask because 3 years ago my mother suffered a scenario very similar to your mom's -- she was hospitalized for "intractable back pain" secondary to spinal stenosis -- which is her correct diagnosis -- but over the course of the next 4 months she had multiple treatments including physical therapy rehab, and several epidural injections which eventually provided great relief. All of this care was co-ordinated by a neuro-surgeon, who, as in your mother's case, had a PA who actually handled most of the office visit "face time". At one visit we did meet with the MD and when we reviewed the bill (months later, AFTER Medicare and private insurance had paid)we realized that he had billed $1050 FOR A 15 MINUTE OFFICE VISIT!!!!!!!!!!!!!!!! AND WORSE -- MEDICARE AND THE PRIVATE INSURER PAID IT WITHOUT QUESTION!!!!!! It was only when we made inquiry that any investigating/adjusting was done.

The private insurance industry is strictly a for-profit enterprize.... they are not interested in the well-being of anyone but their shareholders. For that matter, the Medicare program is a huge, unwieldy, inefficient bureaucracy that lacks adequate internal and external oversight.

That said, I'll take the Medicare program any day of the week. Both Social Security and Medicare are two of the few truly good ideas our government has proposed -- they COULD be simple and efficient -- they are already immensely popular and enjoy bipartisan support OF THE CITIZENS OF THIS COUNTRY.

For the last 30 years politicians have been dragging out the boogeyman of a failing Social Security and Medicare system, one that could be easily fixed. Simply take the cap off the FICA tax limit and be done. At $100,000-plus currently it captures a huge percentage of wage-earners. For those making above that amount, it is an affordable investment in the quality of life for our seniors (and I know because I am in a higher tax-bracket)
It will increasingly be our job as health-care consumers (because, yes, we ARE paying "as we go" for Medicare) to monitor our providers' billing and the scenarios of inefficient delivery of care. Unfortunately, so many using the Medicare system are in no shape to be poring over billing codes and questioning discrepancies.

It is exhausting to endure this continual politicizing of an issue that should speak to the best of our national values, not one that is beset with fear and greed.

I too will NEVER vote for anyone who supports disbanding Social Security/Medicare.

May 27, 2011 6:02 PM

May I share the reasons I am afraid to think of what is already happening with Medicare? At 70 years old I very suddenly needed to be seen by an OB/GYN and tests sent to laboratories showed that I had Endometrial cancer. I would need to have all related female parts removed as well as any surrounding lymph nodes. Test after test were performed. One month later my NYC OB/GYN Oncologist performed a six hour total hysterectomy and surrounding lymph nodes. Fortunately for me, this was a grade one tumor and was caught pretty early. At any rate, Medicare and my supplement were charged $20,270.00 for the six hour surgery. Medicare considers the operation to have been worth $1,634.57 and paid $1,307.66. My supplemental paid the remaining $326.91.

Do any of you remember that we used to purchase emergency (hospitalization) insurance and those who could not buy insurance were taken care of by our hospitals? We would pay out of pocket for doctor's visits and it was affordable. These very same doctors would also take care of those who could not afford to pay.

How can we hope to have the best doctors remain in practice if they are not paid properly for their expertise? And what in the world is going to happen with all the new Medicaid patients coming into the same Medicare system that has run amok - in a society where anyone can sue and sue and sue? Would you ever suggest to anyone that he/she attend Medical School? I would not unless that person never needed to earn a living).

I am grateful for my insurance coverage, but I am most unhappy that our system is so rife with stupidity. I am so pleased a young man named Paul Ryan has taken the time to analyze our situation, current and future, and come up with some specific proposals. Certainly we can not expect a functioning medical solution with the current health care "deal" agreed to by those Senate and House lawyers who know NOTHING about medicine.

GM

May 27, 2011 7:10 PM

PM said: I confess that I don't know what was in the Medicare bill. But having worked in the medical insurance field for 30 years and having dealt with insurance companies, I would be very concerned if private insurance companies are given total control over my Medicare insurance coverage. One thing I didn't see mentioned by any of the comments that I read, was that one way they will save money is to deny benefits. It's already happening. Just because you are paying for medical insurance, don't think for a minute that you'll necessarily get to use it. There are more restrictions on people, and people are not allowed to stay in the hospital even when medically that's where they should be. One of the favorite sayings we have in the hospital field is that people are being sent home "quicker and sicker". The insurance companies (and Medicare too) are expecting patients' families to do some of the care that once upon a time was done in the hospital. A good portion of our health care money goes directly into the pockets of CEOs and to the insurance company middle man...doctors, nurses, office people who are all monitering whether or not they should pay for certain necessary tests or treatments. Also, many insurance companies refuse to pay for certain medications that patients need. Some people don't do well on generic meds but their insurance companies may not cover the use of the brand name med. In some cases, patients' doctors are able to write letters and the insurance company will allow the brand med, but not in all cases. And as someone here also mentioned, these companies are for profit and have stockholders whom they have to please. I don't think I would want my medical care contingent upon how well a company's stock is doing. For people who do have concern with Medicare fraud or any other insurance company fraud, they can call their insurance company and question any charges that seem inappropriate. And they can also call their state's insurance commission or Better Business Bureau with complaints. Another thing I want to mention is that for people who have no health insurance, very few doctors' offices will even give them appointments. Things always sound good in theory, but in actuality sometimes, it's a completely different situation. I don't know what the answer is, but I do know that we need to take care of our elderly in this country. God bless America!!

Our favorite saying for insurance companies is delay, deny, & delete.   I'm tired of filling the pockets of the insurance companies and they inturn fill the pockets of the politicians.  Gold Bless America!

May 28, 2011 10:14 PM

when congress and all other freeloaders have the same insurance as medicare,then i will agree to this plan????

June 10, 2011 5:37 PM

Don't you get it?? All those visits are BECAUSE Medicare devalues humans by not fairly paying doctors. All those additional visits may just make up for the losses. C'mon! A $20,000 operation for $1600? Is that fair? And what does that say about the value of the patient? Perhaps the costs would come down if Medicare paid a realistic rate.

Doctors, other medical professionals and facilities do not have to accept Medicare. If they get fed up enough, or can't meet expenses, they'll just stop seeing Medicare patients. That will be a health care crisis!

As true to capitalism, competition is king. Why do you suppose there are so many health insurance companies? Why do so many heavily advertise? BECAUSE THEY WANT THOSE DOLLARS! Without those dollars, shareholders don't make money. Shareholders also have voting power, so management is accountable for profits, or lack thereof. Competition requires companies to make their benefits attractive to buyers. Some of the shareholders also buy into the company.Do you really think people will buy, or shareholders tolerate a company that cuts benefits and loses customers?

The gov't competes with no one, so it can pay insultingly low claims,or none at all, without consequence. Beneficiaries are stuck. Furthermore, Medicare--and the Part D [no] benefit--is forced on those of a certain age, whereas health insurance is not. Beneficiaries are penalized for joining too early, or too late. Not the case for private insurance.

Although supplemental insurance is not required, I recently had to purchase a policy. I'm on Medicare due to disability, not age. Thanks to miserable gov't sponsored Medicare reimbursements, my vendors can no longer meet my needs on a hardship waiver, so I buy a supplement. There were at least 20 choices--CHOICES--and all within $1000 of each other. After plowing through the benefit packages, I picked Blue Cross, still called the Cadillac of health insurance. Surprsingly, it was less expensive than many companies with lesser benefits.

This is what's so very wrong. Our skewed pespective is that medicine and insurance are obscene because a very good living can be had, while providing service to virtually everyone. Yet, union leaders, who provide limited benefit to an exclusive group only, also make as much or more, without a whimper from anyone.

Yes, I'd rather choose my provider. I trust our capitalistic system and have reaped direct and great benefit from its existence. You go, Rep Ryan, with your courageous self! I'm ready for my freedom of choice!