Well, it's wake up time. I hit the "donut hole" in my prescription drug program. For those who have no idea what I'm talking about, the Medicare Part D program got written by the insurance industry, not Congress. So they put in this nice little present for themselves, that screws those of us unfortunate enough to have serious medical problems. It's called a coverage gap.
Every year, you hit a certain dollar amount which includes what the insurance company has paid for your drugs, what you have paid in co-pays AND what you have paid in premiums. It's that last little bit that shocked me. So they add up the cost of my prescriptions, including the ones I pay 100% on because they don't cover that particular drug, and throw in my premium payments. And when you hit the magic number, BANG you've hit the coverage gap. Now you get to pay your premiums, and pay 100% of the cost of your drugs. In my case, I have to pay 100% until I have paid out $4,050, at which point they will resume payment of 50% of the drugs.
So, since I make $4.00 per month more than is allowed for prescription drug assistance, my prescription costs just jumped from $122 per month to $918.37 a month. That's a great insurance plan, isn't it? I can't stop taking the drugs; they're what's keeping the cancer from returning, among other things. But I begin to understand why people die from not taking their drugs. I understand why so many seniors are cutting their pills in half, taking less.
I don't know what I'm going to do for the next two months. I don't know what I will do next year when this happens again. We will be better off of course because we will be living in a house we own with no rent. But for now it is a huge shock, a crisis of sorts.
Guess I'd better try to sell some of these quilts. In this economy...
Would someone please explain to me why it is that the United States is the only major country in the world that does not have universal health care?
Saturday, October 11, 2008
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5 comments:
Shoshana, I am so sorry. There really is no explanation for it. I have always said that it's not the medical profession nor the legal profession that has gotten us into this health care mess. It's the insurance industry. The insurance industry is every bit as bad as the banking and oil industries, both in terms of greed and incompetence.
I have high hopes that Obama will be able to change things.
Would someone please explain to me why it is that the United States is the only major country in the world that does not have universal health care?
Historically speaking, I think it's partially an outcome of racism, of wanting to make sure that those who are "undeserving freeloaders", i.e. not white, don't get a "free ride". Otherwise, universal health care might have come to pass during the New Deal.
Like racism itself, it's insane. Even if one buys into the idea of the freeloaders, those who are uninsured often end up seeking help at the emergency room. That ends up being a far more costly and inefficient way to provide health coverage than simply having universal health care. Of course, there are those who would prefer to turn the uninsured away from the emergency rooms and let them die or rot, thus "solving" that particular financial issue.
I think another issue is that there are many in the U.S. who take negative pride from not learning from the rest of the world.
I hope that 2009 will begin to bring some positive changes for all, and that major ones come your way.
Insurance payments for those who do pay for their insurance is so high and there is still a deductible. I find myself never going to emergency rooms as my insurance doesn't pay that much toward the bill...I suffer until I can get to a doctor's office on a business day...I feel for those without insurance...expecially the kids....but I think that our country can not provide all medicines and all medical coverage to everyone for free...there are some who would rather have that pack of cigarettes or that night out on the town instead of saving their change for their medication. Everyone should be willing to pay something toward their insurance..it just can't be free.
Shoshana - please don't dispair just yet - some of the drug companies have patient assistance programs that you may be eligible for....I used to help patients in the dr.'s office fill out the forms,and most often they were approved.
Go to www.needymeds.com, it is a drug assistance program locator, tells you who qualifies for what, some of them allow a lot of income and home ownership. You can get the form on line for most of them. Go look up your meds by name, and don;t rule out generics
Why we do not have universal coverage is simple really, if we did, no other country could afford to. their systems are based on US drug companies giving them no cost or low cost meds in exchange for tax write offs on their US taxes. So they do no research and development, no production, they also get equipment from US manufacturers under similar deals. They also offer the drug assistance programs to get tax breaks.... the wealthy and insured in the US pay for it all. It would be like a house of cards falling if you disturbed the way the deck is stacked. Drug companies make more money in health care than doctors do, so do health coverage insurance companies, it is a system that profits both of them, it will not change without a war. People who blindly blame doctors have no idea who holds the cards. I have seen the game played with my own eyes during 30+ years in health care...
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