I CAN’T AFFORD DIABETES!

(Robert A. Berenson, John Holahan)

(Frazer Chronicle)

 

I’m going this one pretty much solo, as most of you who are regular readers know, I strive to get as much factual information about the subject matter that I write about. In this case…..the medication that I take, it’s pretty much a slam dunk, and straight forward. But yesterday I was completely caught off guard by the price of some new medication that actually keeps me alive…..without it I’d probably curl up and die.

I’m talking about the insulin that I’ve been taking since my hospital stay and open heart surgery early last month. My lovely wife has been taking care of all of my prescriptions inventory, and the projected costs, and doing a damn good job. However yesterday we went to our friendly Wal-Mart and got a real shocker, the cost for my insulin was more than $600, or a little over $200 a month.

I grudgingly paid the smiling pharmacist and dutifully when to the snack restaurant to wait for my wife, and to tell her the news about my latest pharmaceutical adventure. Her reaction…..how do you spell flabbergasted…..anyways it what she was…..completely and utterly flabbergasted.

She immediately dispatched on a return visit to the pharmacy with one burning question…..WHAT THE HELL IS GOING ON! The lady at the counter calmly told me that the one insulin, Lantus had an over the counter price tag of $1,040 for a three month supply. Two times $1,040 adds up to $2,080…..of which our insurance rider, and Medicare picks up all but $1,600.

To complicate the issue, I was at my donut hole…..(thank you very much President Bush) and therefore was expected to pay 50% until I reached $5,000, and then Medicare would take care of most of my medicines.  Our insurance rider, a supplemental to help cover us also honored the stupid donut hole…..and why wouldn’t they, and would pay after the $5,000 figure was reached.

Now here I was, in a real life dilemma, just like you read about in the newspapers, an old guy, down on his luck, mesmerized by the maze of health insurance, with little choice or recourse to challenge the high cost of prescription drugs…..drugs that was absolutely needed to perpetuate his life. Am I singing the blues loud enough…..I certainly hope so, cause I’m really, really trying my hardest.

The cost really is prohibitive for us, that’s $2,400 additionally a year that we’re going to have to scrape up and pay, donut hole be damned, I really don’t trust anything that the government might have to say about my care, or my prescription medication.

THIS IS A TIME IN MY LIFE WHEN…..

I’ll be 70 years old in less than two weeks; I’ve just had a medical procedure, one that knocked the pins out from underneath me. The last thing I need on my road to recovery is an unexpected $600 dollar financial bomb.

And I’m also going to have to worry about my hospital stay at the Hotel Saint Vinnie, that’ll cost me in excess of $2,500. Hell I’m gonna have to throw off my hospital issued bathrobe (courtesy of Saint Vincent) insulin and all,  and find gainful employment somewhere to cover my cute little butt with these incurred medical costs.

Mind you I’m really not complaining, this medical snarl of complexities is little more then another challenge along life’s path. I’m an old trooper, I’ll simply take whatever life shoots at me one day at a time, and hopefully make the right moved to stay at least a half step ahead of the game.

The care in the hospital that I received was fantastic, the nurses were tremendous, cute, and showed just the right amount of bosom…..thank you very much. But there is a question here of treatment…..overall treatment. The time that I spent in the hospital, and the life adjustments that I’ve had to make, for me seem to be overwhelming.

Recovery from my type of procedure is tough enough without my wife nipping at my heels all the time about what I eat, when I should take my meds, and my monitoring of blood-sugar. Oh, I’ve made my own bed; rest assured that I understand that, I have nobody but myself to blame for the physical shape that I now find myself…..however!

My recovery seems to be going just fine, I have little or no pain, my blood sugar seems to be controllable, my blood pressure is that of an 18 year old, I’ve lost about 15 pounds, and I’ve excepted my new diet and the changes in how I’ll need to lead my life at least for the present time.

I figure that I’m becoming a productive member of society once again, and will, after my recuperation period which can take as long as a year, be able to resume much of what I did, activity wise. It’s what I’m working towards, I walk every day, and in about a month I’ll start some sort of weight lifting program to regain more of my physical strength.

DID YOU REALLY EVER READ THE MEDICARE ACT

I read bits and pieces of the act, but never really concentrated on understanding what was said, what it meant, and how it would eventually affect me. Medicare is a national social insurance program that is administered by the United States government since 1966. Medicare guarantees access to health insurance for Americans 65 and older and younger people with disabilities as well as people with end stage renal disease as well as persons with Amyotrophic lateral sclerosis.

As a social insurance program, Medicare, like any other insurance spreads the financial risk associated with illness across society to protect everybody. The only way that Medicare differs from private for profit insurance is that the private guys manage their risk portfolio by adjusting their pricing according to perceived risk.

In 2010, Medicare provided health insurance to 48 million Americans, 40 million people aged 65 and older and 8 million younger people with disabilities. On average, Medicare covers about half (48%) of health care costs to enrollees. Medicare enrollees must cover the rest of the costs, these out-of-pocket costs vary depending on the amount of health care a Medicare enrollee needs.

So at the present time, even with the early immergence of Affordable Care (Obama-care), people that are sick, get injured, or succumb to so called catastrophic diseases are required to incur out-of-pocket-costs that are usually un-reimbursable, unless you are willing to pay tens of thousands of dollars a year…..there is insurance for everything…..and somebody out there in the insurance world will write insurance for anything.

THE MEDICARE PROGRAM, IT’S PAST AND FUTURE

In 1965, President Lynden Johnson, and Congress created Medicare under Title XVIII of the Social Security Act to provide health insurance to people 65 and older, regardless of income or medical history. Needless to say, before the act, only about half of older adults had health care insurance. Before Medicare’s creation, only half of older adults had any kind of health insurance, as coverage was either unavailable or unaffordable. Medicare also spurred the racial integration of thousands of waiting rooms, and hospital floors, and physician practices by making payments to health care providers conditional on desegregation.

 
According to the last comprehensive study of the Medicare population, which occurred in 2006, the average household income of Medicare enrollees was $22,600 compared to a U.S. median income of $48,201. In 2008 16% of Medicare enrollees were living in poverty, compared to 13% of the general population.

According to the U.S. Census Bureau and Saperston Companies, Bankrate and verified 5-3-2013, 35% of retirees survive solely on Social Security and 36% have no savings whatsoever with 65% dependent upon Social Security,  friends family and/or charity. The typical senior household has $66,900 in savings, while studies suggest that the average man will need $124,000 to cover health care during retirement, while the average women will need as much as $152,000.

Of course the average Medicare enrollee also has substantial health care needs compared to the general population. Roughly 87% of Medicare enrollees have at least one chronic health condition, and nearly half have three or more issues of chronic health needs, compared to 21% and 7% respectively of the general population. 47% of Medicare enrollees have some kind of activity limitation.

We are an aging society, medical procedures have lengthened our life expectancy, lifestyles and dietetics have both worked to extend our lives and also the quality lives. Could it be any other way, our medical profession strives to cure known pathogens, and is doing so at an expanded and fast track rate.

The future of Medicare at the present time is less than bright, the Medicare fund, those younger insured folks that will usually not need medical treatment until they are in their forties or early fifties is shrinking, and the costs to older people who on average last longer is raising…..which means that Medicare will run out of money…..and then what do we do?

Of course there are some who criticize Medicare, arguing that with the birth of Medicare, there has been a shift away from personal responsibility and towards a view that health care is an unearned (entitlement) to be provided at other’s expense. To these people I say bah and a good old fashioned hum-bug these people are idiots…..and village clowns.

The essence of the problem is that as a nation we’ve gotten ourselves into a skewed set of priorities…..when defense spending trumps citizen health care…..something is really graphically wrong with the thinking process in use. The high cost of health care for the aged combined with the generally low incomes of retired people spells doom for the Medicare program in place at the present time.

It’s time…..past time to reprioritize where we spend our money…..government does not have a money machine, government does not print hundred dollar bills without the prospect of gaining the money from some sort of tax…..we need to totally understand that aspect of government.

HAVE A NICE DAY!