More to be said: My own version of a panel discussion on health care

Do you remember panel discussions? Panel discussions usually involve a bringing together of a cross-section of views about an issue. With all of the hollering and worrying about the health care issue, and the government shut down, I have been listening. What I want to see, really want to see, is solutions that address and resolve EVERYONE’S concerns. I want to see it done with respect, and I want to see it done in a timely fashion.

I have family members with pre-existing conditions. I have had family members with astronomical bills. I have friends and family members who have a great deal of concern about the government meddling into private areas. In the past they were laughed at for being worried. As the health care act is enacted, people will see the impact of it. But for now, I am going to let you know what some of my wise and eloquent friends have had to say. Let it be said that every single one of these people is devoted to caring about people, and wants the best for them.

Pattie”I think everyone agrees that something needed to be done about healthcare — But many feel that “the health act” is not the answer. Affordable is relative. Who is going to pay the bills? What else is hidden in that act? I doubt anyone wants this bill repealed so as to take healthcare away from someone in need — There was an incredible opportunity for our government to step up to the plate and address healthcare — to do something for everyone…. and they dropped the ball — very frustrating.”

Mary “my employer could not afford the new premiums. He is the owner of a very small business”. The affordable hca premiums in my state are not affordable. We cannot afford them at all. We make too much for Medicaid, and subsidies. The out of pocket deductibles are 2k each and the premiums $ . Plus there is no faith exclusion for organizations who are opposed to paying for abortions as a matter of their faith, but their companies are required to offer it.

R “I cannot speak to the medicare part D drug coverage program, but in my experience working for and with managed care insurance plans the practice of denying medications, treatments, or procedures as “experimental” has been the norm for many many, years. Typically for a medical procedure it could be sent to review by an MD in the insurance co. for a final determination. For medications the process for second review should be available as well. Especially if the first line drugs have been tried , proven ineffective, and documented as such. There may be avenues through which to appeal the decision in some cases, maybe your mom would be able to do that at least through BCBS? I understand your strong feelings, but I wonder if there is more to this than something that is a result of the ACA directly, especially since many parts of it have yet to be implemented. I believe the “experimental” factor will unfortunately be found throughout all number and types of health plans. I am glad that she can, for the time, receive her medication through the assistance program. I am sorry for the stress, frustration, and difficulty this places on your family. It is hard feeling like you have to fight for what your loved one so desperately needs.

 Angela:

 The medication in question was covered under her BCBS plan until changes due to implementation of Obamacare. They told my mother that the change was directly attributable. It was covered until it wasn’t. I appreciate your point of view but I cannot support this legislation as any real answer. It solves the issue of one body of citizens at the expense of another. Socializing medicine won’t fix the issue as it creates more issues. We can certainly agree to disagree. It’s a tough subject and I can understand how your heart can weep for those who don’t have the coverages they need but I have watched a loved one be directly impacted in a negative way due to this legislation (let’s not get into the increases to health care costs that I am seeing as a single mother with no support). It’s good when you’re on the receiving end of the benefits of this thing but when you’re the one paying the price for others, it doesn’t feel so very good.

R:. Your mom seems to have a different situation having first had the med covered and now declined, sorry I missed that specific detail in my tiredness. I can understand your intense feelings under the circumstances, with your mom being told this is a direct cause. One problem I have with the system, is at the end of the day insurance companies are still out to make a profit. Having to look at their bottom line, keeping a float, and still having enough money to line the pockets of their CEOs is what they are driving for. So with these companies contracted to provide healthcare to those enrolled in govt programs like Medicaid and medicare , and now ACA the for profit mentality is still in the background.It’s imbedded into our system, not sure how to change that. If pharma could be reigned in, and insurance not be run as a money making endeavor with millionaire CEOs and stocks, then better changes might be possible. Unfortunately money rules , and much of our representatives are owned by those with the money who can afford to defend their interests the loudest and longest. It’s a mess, but all the fighting and government stalemate shut downs won’t help it. I believe Kate is right, that discussing in a rationale way and writing to Congress about real experience is a positive step. There are real concerns on both sides of this topic, but all the fear tactics about untrue things about the ACA has led to an extremely volatile response on unfounded issues. The real issues need to be focused on and worked through.

  • C::  My apologies on using the Obamacare language. Unfortunately our society whether it is because they don’t care, don’t understand, aren’t interested or just refuse to get educated don’t know what the Affordable Care Act is. As a CPA I have spent many hours educating my clients and it has only just began. Whether I agree with it or not it is here for the time being and we must live with that. However, having spent many hours studying the ACA, I will tell you many of the insurance issues we have had are not because of it. What an insurance company covers this year may not be the same as next year when many of the mandates kick in. A,, while I sympathize with your situation experimental drugs are rarely covered by insurance and medicare has never had very good prescription coverage. that is why there are trials for experimental and new drugs. Often families can get help from the companies. I am currently on a very expensive therapy and I have a very high deductible insurance and can’t afford it. The drug company is picking up most of the cost. This isn’t the first time our family has had assistance from the drug company. Sometimes there is assistance available but no one has helped us find it. 
  •  A.
    It’s a tough subject and I respectfully and knowledgeably don’t agree that any legislation that effectively socializes medicine is the answer. Dismiss my family’s experience but there are NUMEROUS examples across the globe that demonstrate the negatives of socialized medicine. The legislation is a mistake and I can only hope that our lawmakers listen to the growing group of citizens who realize it shouldn’t be implemented and should be repealed. Just because we are a nation of mostly asleep at the wheel people doesn’t mean that this is a good change for our people or one that shouldn’t be changed. Let’s face it, when Congress has to exempt themselves from the program (and “special” businesses), surely that’s a sign something doesn’t work here.
    P.
    As the bill is implemented, perhaps people will see rational proof that the system works better than what we had. I had initially said that Congress had no right to shut down, as Elizabeth Warren said so eloquently. I’ve been thinking lately, and I’m not so sure that constitutionally, Congress is required to fund the law. Article I, Section 9, Clause 7 gives congress the power of the purse, saying that no money is to be spent except by congressional appropriation. And as a power granted without the right to choose when to exercise it is not really a power, it’s my new opinion that the Congress is within its right, technically, to be doing what it is doing. Not that I like it, but …
    L: I am terrified that the new health care law will damage the system even more. I am fighting cancer, and desperately need health care, treatments (whether they are long-standing or experimental). I want to live. I do not want to be bankrupted financially, but I do not want the government taking things over either.
  • Misc input: multiple people that I know who are on Medicare and Medicaid are destitute, and are continually having to choose between food and medicine.
  • Misc input: multiple people have already had intrusiveness from the government and insurance companies — and to doubt their experiences or dismiss them is wrong. We must be wise, and know that programs seldom end up truly helping those they intend to help—at least as much as was thought. Besides that, there are always unintended consequences.

+++

Here is the thing folks. We have to all get through this life together. Those of us who HAVE need to be generous and give to organizations that help those who are suffering. We need to urge pharma, government, and each other to work together and help. No more unkind words. Do you remember the movie Dave (starring Kevin Kline and Sigourney Weaver, among others?) There is a scene that takes place after he finds out that the funding for the First Lady’s homeless shelter has been cut. He calls the cabinet together and reasons with them, and asks them each to be willing to cut something. He does it so beautifully, and so reasonably. NOW we all keep screaming at Congress and the pharmacy companies to do something.

Some of us can contribute to foundations that help folks with medical bills. Many of us cannot afford to do that. But we can write. We can write letters and emails to the foundations, to the companies, to congress. We can ask them to care more about truth and compassion than winning, and beating the other side.

+++

Ok—those of you have made it to the end of my little “panel discussion”….. I hope you know that I am a caring individual. I hope you know that I do not want “intrusiveness” or “death panels” or bankruptcies. What I do want is for people to have access to the medical care that they need. The government is shut down, but our hearts are not. No one can stop us from giving and caring. Those of you who blog—get your readers fired up for compassion and caring. Love to you tonight, and take heart. The fight for goodness is not over. I don’t care about who started the fight. Let’s roll up our sleeves and help every person in our lives that we can help. That would be a good start. Whether your help is in the form of researching what organizations exist that help folks with medical bills, or what pharmaceutical companies have to offer for people who cannot afford their medicines, or volunteering at clinics, or WHATEVER. Congress will continue to fight. We must continue to search for the high road. That’s what I have to say.

Aren’t my friends each the most amazing, wise people?

 

About Kate Kresse

I love to write, I love to talk, I love to uplift people when I can. I am a woman in love with life. I am a wife, mom, tutor, writer, and I am a perennial optimist. (OK not every single minute but you get the point! :-)
This entry was posted in Affordable Care Act, faith/courage/miracles/hope, politics, Positive Thinking and tagged , , , , , . Bookmark the permalink.

12 Responses to More to be said: My own version of a panel discussion on health care

  1. auntyuta says:

    Kate, you say: “What I do want is for people to have access to the medical care that they need.”
    Well, isn’t that something that just about everyone ought to be willing to agree to? It still boils down to how can you make it affordable? If a rich nation like America cannot afford basic health care for all its citizens then which nation can? I am sorry, I don’t get it. Please explain!

    • Kate Kresse says:

      Uta~ I think everyone out to be willing to agree to it, absolutely. The problem has become that each side is villifying the other side as uncaring. As a result, there is a lot of ugliness. America continues to provide some level of medical care through Medicaid (which is for folks below a certain income level) and it’s senior citizens through Medicare. However, there are MANY procedures and medications that are not covered because they get classified as “experimental”. Furthermore, medications have a “doughnut hole”—meaning the program pays for medications up to a certain $ amount per year, then there is a gap where the person has to cover it up to another total $ amount, and then the “plan” picks it up again. I know people who really suffer due to that.
      The bulk of coverage in this country, though, is through insurance plans provided by insurance companies, not the government. Many people have been going without coverage, as companies could either refuse coverage if they had any sort of pre-existing condition, or price the coverage so high that the person could not afford it. Part of the Affordable Care Act rules is that companies can no longer do that. Thus, all of the people who had pre-existing conditions can no obtain coverage from these companies. As a result of that, though, the total risk and expenses from taking those folks on gets spread over everyone. That means everyone who did not have the pre-existing conditions will cover part of the medical costs, too—since insurance works on expense/risk types of methods.
      Furthermore, insurance companies (or Medicaid/Medicare if that is what you have instead) is the ultimate decider as to whether or not they will permit/pay for a particular procedure for a particular patient. Sometimes they decide that they won’t cover it, even if it could save the patient’s life. For instance, if someone is 90 and needs a heart transplant (and the doc believes the patient will do well with the surgery and recovery) the insurance company (or Medicaid/Medicare) will still decide they won’t allow it. This type of decision making power is where the hollering about “death panels” is coming from..
      Now, as far as America being rich, we currently have a debt that is in the trillions. We spend WAY more than we take in in taxes. That is an entire OTHER argument!
      Regarding the costs of prescriptions. It costs a LOT of money to develop/create a drug. Years of research and development by highly skilled/educated scientists. Then there is the testing and regulatory hoops to jump through to bring it to market. Part of the problem is CEO salaries, but the pharmacy industry employs a lot of scientists, office workers, factory workers, nurses, and more.
      Costs for doctors, labs, and hospitals….Costs have increased astronomically. Part of the problem there is that the cost of malpractice insurance has increased by certainly over 200% in just the past few years. Since hospitals and doctors need to make some sort of profit to stay in business, some of those costs get passed on to consumers as well.
      In the US no hospital is allowed to turn ER patients away for lack of ability to pay. Those patients costs get passed on to others and no doubt to other departments as well.
      Part of the irritation of the general public is that the lawmakers have a different and luxurious medical plan (paid for by the taxpayers). If they were subject to the same $ limits and insurance plan as Medicaid patients, that problem would be fixed instantly.
      Another issue that some have with Obamacare/Affordable Care Act is that companies/organizations are required to purchase medical insurance for their employees—that isn’t necessarily the problem. the problem is that even if the organization is let’s say a pro-life organization, they are required to include in their medical insurance policies a provision that pays for abortions. The only exclusion is for actual churches. If the companies do NOT offer this, they pay a heft fine every day. Since one of the provisions of our Bill or Rights involves freedom of religion, this, too became a huge bone of contention.
      Let’s just say…..It’s complicated!!

      • auntyuta says:

        Thank you so much, Kate, for going to such length explaining a very complicated situation. You are immensely well informed and explain everything so thoroughly. People should have people like you in congress to speak up for them. For people who believe in prayer I say a lot of praying might help in overcoming the crisis!

  2. theladypeach says:

    Auntyuta, I don’t get it either. If this gov’t thinks it has to charge exhorbatant prices for insurance, where is that money going? And why take it away from those that need it the most? My personal opinion is, I wonder if they want more to go into their pockets.

    • Kate Kresse says:

      I am guessing that Congress would fix it instantly if they were REQUIRED to be on Medicaid for their medical insurance and were not permitted to buy any additional medical insurance. Then we would see what is essential and what is experimental. The doughnut hole would be a thing of the past, and so many more things would be fixed. I am sorry for all that you go through. The fear and going without must be draining and exhausting.

  3. theladypeach says:

    I have a sneaky feeling you are right! As long as they have everything they want, they couldn’t care
    less about the rest of us. And, if it takes someone else insurance to get them a new tinker toy, that’s all right with them. I think THEY are the reason we are so far in debt and in this mess.

    • Kate Kresse says:

      it’s a bit inevitable in a way. We want people to go to Washington to fight for what is right. This encourages fighters to join the ranks in Washington. Often when we say fight we really mean Crusade and negotiate. But they end up feeling they would rather win and be “called” right than to seek truth and compromise. If we could have a form on our taxes and each indicate which programs we want what % of our taxes to go to, and they had to FOLLOW our instructions, it could very quickly become clear what we want to fund through our taxes. ESPECIALLY if we had to indicate what % of our taxes we want to go to the politicians (and their fancy healthcare plan and pensions).

  4. theladypeach says:

    Thank you! The last 2 nights I have tossed and turned until I woke myself up. Then I couldn’t figure out why. I took 3 naps this afternoon so now I don’t know if I will sleep tonight. Yes, the stress drains me till I wonder which way is up.

    • Kate Kresse says:

      i took a nap this afternoon too!! If you see me post in the middle of the night tonight, feel free to “pop in”….But I plan to take some calcium magnesium tablets, a glass of milk and have a warm bath. Hopefully I will sleep!

      • theladypeach says:

        That all sounds good! I wasn’t aware of the tablets. My sinisues got so dry out that didn’t help any thing. I called the O2 people to come check the concentrator as it won’t put the water through I’m going to try and finish my mail and then lay down. I’m really sleepy..

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