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Medicare for More?

Published July 6, 2009 by Quinn Phillips

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People with diabetes — like those with other chronic conditions — tend to deal more frequently with doctors, nurses, hospitals, insurance companies, and other elements of the health-care system than the average person does. As a result, they stand to benefit or suffer disproportionately from any change in the health-care system. So as Congress and the president ramp up efforts to create a comprehensive health-care reform bill and pass it into law, the diabetes community is paying close attention.

DiabetesSelfManagement.com is no exception. Last month, blogger David Spero promoted the virtues of a universal national health insurance program (“Health-Care System Needs Healing”). Diabetes Flashpoints has also featured questions about the health-care system a few times this year.

It has become clear so far in the debate on health-care reform that many Democrats in Congress, as well as President Obama, would like to create a widely-available public health insurance program as an optional alternative to private insurance. Among the many questions about what such a plan would — and should — look like, there is one frequent point of comparison: Medicare. This government-run health insurance program for Americans ages 65 and over is well known, and practically the same, in every corner of the country. It is also the only real-life example of health insurance being run by the federal government.

So it is natural to ask: How is Medicare doing? This is the topic of a recent article in The New York Times, which explores the strengths and weaknesses of the program. The article concludes that Medicare does a good job delivering needed care and holding down costs, but could do a better job weeding out unnecessary care and incorporating innovative changes in its structure (for example, prescription drug coverage was not added until 2003). Almost everyone seems to agree, however, that the country is better off with Medicare than without it.

What do you think — do you have personal experience with Medicare? Are you satisfied with it? Do you think it would be a good model for a widely-available public health insurance option? Leave a comment below!

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Steve Parker, M.D.

“Almost everyone seems to agree, however, that the country is better off with Medicare than without it.”

Actully, most people never even think about the existence – or not – of Medicare. It’s like the public school system, in that respect – it’s just there and always has been.

It’s great that you’re opening up this dialogue.

Participants in the discussion need to ask themselves, first, “What is the proper role of government?” Here are some potential answers: 1) defense against threats to our nation, 2) protection of individual rights (e.g., life, liberty, pursuit of happiness, right to own private property and make contracts), 3) enforcement of laws and contracts (a justice system), 4) maintain a system of money, 5) provide for the general welfare when NO OTHER system can do so (example: the space program that has led to weather and telecommunication satellites).

Do you believe the government should provide everything we need from cradle to grave – food, clothing, housing, jobs, medical care, transportation, insurance, electricity? If so, you will have a particular answer to the Medicare question.

I’m not the only person who believes that the larger government gets, the less freedom we have. There are better ways to provide for health insurance than having the government do it.

-Steve
susan clark RN, BSN,CDE

Medicare covers 80% of of the cost of DSME and has specific requirements including 10 hours of DSME for first year benefits only, 2 hours years 2 and thereafter. And first hour is 1:1 education with a CDE, the other 9 hours are in groups or classes. In addition, people need 20% coverage with a private insurance company and many cannot afford the insurance premiums.

Medicare D is the prescription benefit coverage which has many loopholes. One is you must qualify and meet income requirements and then there is the donot hole. Many patients cannot afford to get their prescriptions covered when they fall into the donot hole.

Medicare needs help.
michael tingle

I MYSELF HAVE MEDICARE AND I HAVENT ANY PROBLEMS WITH THE SYSTEM SINCE I HAVE BEEN ON IT FOR TWO YEARS I HOPE THAT CONGRESS OR WHOMEVER DOSNT SCREW THIS UP TOO ME MEDICARE RIGHT NOW IS RUN BY THE GOVERNMENT VERY WELL BUT LIKE THEM IF IT RUNS WEEL LETS SEE IF CAN SCREW IT UP EVERY YEAR WE GET A RAISE FROM SSI AND EVERY YEAR OUR COST IS MORE THAN OUR RAISE WHY? IT IS HARD TO LIVE ON ON WHAT WE MAKE AND EVERYTHING JUST KEEPS ON PASSSING US.
Crystal Achey

I am concerned (just as Steve Parker is) about creating more dependence on our government. I am concerned that we will be creating what I like to refer to as a “Medical Industrial Complex” where man made, low frequency, loaded with negative side effects, chemicals and drugs are paid for at the taxpayers expense, while often much safer and effective homeopath and naturopath remedies and therapies are not covered.

I think, if the public wants drugs, they should pay individually and privately. If the government wants to provide health care, maybe they could pick up where private insurance leaves off, by covering modalities that treat the source of the problem, not cover up and create more problems.

Crystal Achey, Publishing Editor
PBMS Media ~ Phoenix Body Mind and Soul
Patricia Thomas

I have been living with type 1, insulin dependent, diabetes for 46 years. I have been employed during much of that time and I am now living on Social Security and Medicare. This government program has been a God send for me. I have been contributing to Social Security all my working years and feel I have a right to receive some of these benefits now that I’m retired. Without Social Security and Medicare I would be devasted. This Government program works and I am so very grateful that we senors have this benefit.
Marje Stone

I have been on medicare for 6 years, diagnosed with pre-diabetes 2 years ago.

Medicare has been helpful. My concern is that specialists are paid so much more than primary care doctors. The primary care doctor is of prime importance in medical care. Also, the difficulty and lack of reimbursement to physicians has created a big shortage of internists and GPs n the area where I live.

The other big concern is the drug benefit. My experience has been that most medications are denied unless they are generic. It seems to me a better solution would be to open up the competition and allow us to purchase medications from other countries. The pharmaceutical manufacturers claim that medications are not safe from other countries, however most of our medications are manufactured in other countries.

Also, it would be big progress if pharmacy manufacturers were not allowed to advertise their medications. This would give them a huge chunk of money for research and development which has been lacking since advertising medications has become legal. If prices became competetive again, drug insurance wouldn’t be needed except in unusual situations.

Marje Stone
JAMES LIGHT

i think the on going problem with the gov run anything is they cut it down for all on the program and those who need it the most the poor having to pay more out of pocket IT HURTS SO MUCH MORE some of us bearly get along now,as it is ,,id say let the super rich,that have large amount of monies for retirement coming in should pay little more ,,,we all would be surprised what some are making for a living after working,iam not saying they didnt work for it but the poor and unforture sometimes not any fault of the person needs some help , gov shouldnt take away more from this person!!!!
Bill

Yes, I have used medicare. For me it is a very good program. Not without its faults though. I am diabetic so I watch this program very closely.

I believe the signature of the patient should be required when seen by a doctor or when special care if given, like xrays or an MRI. This might cut down on the fraud.
s.kinard

i have been very satisfied with the present medicare program.
Richard

Doesn’t work in Canada, Spain, other places. Horror stories on people not getting health care or bein put off until they die. Leave it alone, They already said no more SS increases for 3 years.

Congress and the President leave it alone.

74 year old, worked till I was 72, bad back, artifical heart valve. Say NO to the congress.
Do you know that congress has excempted themselves from the change, they will not be effected. If it’s good for you, why isn’t it good for them.
M. Yarrington

I am a type 1 diabetic. I find it interesting that Medicare pays for my meter, my test strips, and my lancets to determine how high or low my sugar is, but does not cover the cost of treating it. I pay a lot of out of pocket dollars for 2 insulins which is what puts me in the donut hole each year. Wouldn’t it make sense to not only enable people to discover they have a need for medication but also to help pay for that needed medication? And although I have read the reasoning why insulin cannot be made as a generic, I’m not so sure that that is only what the pharmaceutical companies want us to believe. If Walmart can have generic NPH insulin, how come that other insulins cannot also be made generically?
James D.Taylor

Thought I’d post a bit on an issue near and dear to my heart-healthcare,(Or a lack thereof)and it’s cost in the US for persons like me well into there 45th year of living with a chronic condition.
Since the age of 5 I’ve watched healthcare in our country go from 100% coverage for ALL MEDICAL EXPENSES to a hodge-podge of allowances, exclusions, co-pays, “donut-holes” etc. While the technology for monitoring and controlling my Type 1 diabetes has greatly improved over the 45 year period I’ve survived with it the cost increases have greatly outstripped those gains by a wide margin and at this point something has to be done to stem the pace of inflation on healthcare costs.
As for me, I absolutely see the irrefutable benefits that a single payer system could provide as it would rapidly change the balance of power in the”economic equation” and would rapidly supplant the profit mongering “cherry picking” middlemen in the equation.
All one needs to see single payer system benefits is to look at what our VA system pays for its medications vs. what you are forced to pay in your current plan for ESSENTIAL LIFE SUPPORTING MEDICATIONS FOR WHICH THERE IS NO AVAILABLE GENERIC (i.e. insulin).
The same warnings, issues and concerns raised by President Eisenhower when he spoke out against the military-industrial complex near the end of his term in 1960 should be given heed today when we look at the medical/pharmaceutical/insurance cabal which is designed to do only one thing well, increase each of those entities profit margins.
Respectfully,
J.D.Taylor
Paula Kilburn

I am new to Medicare but so far it seems good. My only objection so far is that Medicare DICTATES to me and my doctor how much durable medical supplies I can have no matter what my doctor prescribes. This makes it difficult to manage my diabetes.
Bahamut

For people with certain diseases like Cancer, they become “uninsurable” and must rely on Medicare.

Here’s an interesting story about it:
http://www.dailykos.com/storyonly/2009/7/7/751100/-How-I-lost-my-health-insurance-at-the-hairstylists
Richard

Medicare works just fine; leave it alone. The so-called universal health care plan, in my understanding of it, would replace Medicare. Forget it!!!!
Edna Ludwig

I have been on Medicare for 4 years. We have to pay $340.00 {for my husband and myself} to cover the 20% Medicare does not pay. We pay nothing when we go to the doctor or hospital. {I do realize some patients can’t afford good secondary insurance} However, after paying this amount, I reach the donut hole by march every year, because I am on 2 different insulins. My monthly charge has been over $600.00 per month for insulin. I have chosen to get my insulin from somewhere else for more then half the price. The insulin is FINE and made by the same Company I was getting it from , in the US. I do believe something better has to be done with the donut hole problems and the drug companies charging so much for perscriptions.
C. Thompson

Leave the Medicare alone. IT has taken a great deal of time to reached this point. Obama health care would not only foul it up but would limit what we now. Guaranteed!
Buck Carpenter

I cant see why we cant expand medicare to serve all . The existing program has been fine for me .
orean fail

I have been on medecare for 5 years and i can not complain about it . When i go to the hospital i do not have to pay anything up front, because some of the time you do not have the money.
the only problem i have is with the medecare d
plan i have heart problems and is type 2 diabetic
and i have to have certain types of medicine to keep living. i am already in the donut hole and i am on a heart medicine that the doctor said i could not stop taking, and when i went to get a refil they wanted over $600.00 the same with my diabetic medicine. when they put the complete cost of the medicine into the medecare you get
past the $2700.00 very fast. they should talk to the people that is in this condition before they
make these rules.
Lynne Schlaufman

Edna – what in the world kind of insulin are you on? I have been on insulin for seven years and, until recently, took an enormous amount each day and I never came near $600.00 per month.

Anyway, health care is a problem for everyone. I hate the fact that the government has coddled us into believing that the more they “give” us, the better off we are. Health care is not the only area in which that has happened. In every country that has “free” health care – the taxes are high and the people are miserable. The health isn’t any better but the unemployment is higher. People get used to being taken care of and they get lazy. I’m on medicare and it is pretty good. It isn’t free. My teeth are in terrible shape because they aren’t included in it but that’s my problem not the government’s. I worked for over forty years and then became disabled. I’m on disability and would love not to be.

I recently read a comment by a journalist from a country where the government controls the healthcare and I thought he said it all: “If you think healthcare is expensive now, wait until you see how much it costs when it’s free!”
Donna Doepke

I have not been on medicare for very long, but have found it to be very helpful. My doctors do seem to wait for a long time to be reimbursed. The biggest problem is that Medicare is going broke. This seems to be a big problem with anything the government runs. I am not enrolled in the drug reimbursement part of Medicare which I think is not good. My sister takes a lot of medicine and always ends up in the doughnut hole and pays out big sums of money. She has tried generic medicines and all of them have caused her body big problems therefore she has to take the brand name drugs. I find Obama’s health care ideas to be a BIG problem. If we get something like they have in Europe our good healthcare will end up being ruined. Older people will end up getting less care and if they need an expensive procedure it will be denied because older people aren’t productive and therefore not eligible to be cared for. I don’t want govt run healthcare!!
Linda Reyes

I agree leave it alone….I worked for a clinic in California and we had the drug reps come in once a wk to leave samples for the Dr’s to dispense to their patients…The drug companies have got to stop wooing and giving Dr’s special dinners and special gifts for them to give the samples to their patients…Also the reps get a very healthy income
plus they get a company car and they are very nice cars volvos,camery’splus an expense account they need to stop giving all these extras and lower the cost of the drugs with all these perks they have to charge an absorbent price for the drugs
B. A. Borthwick

My opinion is that Medicare is a wonderful program and should remain that way.
PetaMaree

I am on Social Security disability and also on Medicare (even though I’m not 65), with a supplemental insurance policy. Having Type 1 diabetes for 44 years AND CAD for the last 3 years, I feel grateful that there is a program in place, however it does leave much to be desired! With two chronic diseases requiring tier 3+4 medications (no generics and/or drug allergies to those that do have generics) I have been in the donut hole since the end of May and will only reach catastropic coverage in November. In January
this starts all over. My SSD payments just cover my medications while in the donut hole. Do I take my meds and starve to death or do I eat and die? I can’t depend on charity forever with so many others in need. I never thought I would be in this position so early in life. May the legistrator who thought of the donut hole try making ends meet with a chronic disease such as diabetes. Are we being penalized for our disease(s)?
Marcie

I have been a nurse since I was 24 and have worked in multiple fields — from hospital to doctors’ office to physical rehab centers.

I’m not eligible for Medicare for 2 more years, so I’m not terribly familiar with it. But with the “Medical Industrial Complex,” I’m immersed in its operations.

For those who are happy with medicare, I’m glad for them. But for those who aren’t — and for those who worry a great deal about government involvement in health care — all I can say is: Health Insurance companies now dictate care. They decide what medications, treatments, and DME they will allow; and they dictate which doctors that people can see. How is this different from what people fear from government-run health care? The difference is that more people will be able to get the health care and services they need, and the insurance companies won’t get rich off of them.

Over 60% of personal bankruptcies are due to medical expenses. And among those who are victims of this, 78% HAVE health insurance.

I’m not sayhing that I’m gung ho for government-run health care, but I do have to say that it’s past time for our country to try some major changes in our health care delivery system.
Florian

My experience with Medicare for a person living with Type 1 diabetes has been excellent. I have an advantage plan called Medicare HMO Blue.
Under the plan I was able to get my insulin pump at no out of pocket cost. The insulin used in the pump is provided at no cost. My test strips (10 tests/day) and lancets are also provided at no cost. There is a Fitness Benefit that I apply for every year that pays $150 towards membership fees at a fitness center. It doesn’t cover much of my cost to staying healthy and fit, but it helps.
It would be great if a Continuous Glucose Monitoring System was added to the durable medical equipment list.
Linda Reyes

I for one do not want the government dictating my health care.They need to stop playing with our health with universal health care it will be worse it will take months for us to get the health care that we need….I am Diabetic and have been for 24 yrs this disease is not cheap.We can not let government run our health care system…I have been on medicare for 2yrs and it is working very well for me.I don’t mind helping people but when do you put a stop to it for those who choose to not work and just want to lay on the couch and do nothing for themselves..Also a little tidbit I don’t know if any one knows that AARP is very involved with having the government pass the new health care system that just scares the heck out of me….Linda
ODESSA

I DO NOT THINK MEDICARE IS DOING EVERYTHING IT SHOULD BE DOING FOR ALL PATIENTS.I AM TYPE 1 DIABETIC WITH DIABETIC UNAWARENESS OF MY BLOOD SUGAR HIGH AND LOW.THIS IS VERY DANGER TO ME.WHAT I WANT TO KNOW IS,WHY MEDICARE DOES NOT PAY FOR CONTINUOUS GLUCOSE MONITORING SYSTEM,WITH SENSORS AND TRANSMITTER?THE COST FOR THIS EQUIPMENT EACH MONTH IS VERY COSTLY.SO PLEASE HELP US GET BETTER CARE FOR DIABETICS AND ALL OTHER TYPE PATIENTS.WE ALL HAVE WORKED FOR MANY YEARS AND NOW WE NEED HELP FROM OUR GOVERNMENT.PLEASE PUT OUR HEALTH CARE FIRST///THANK YOU
Dianne Marcil

I have always felt that Medicare is a reasonable health insurance program, although it has its flaws. I have been involved with Medicare for over 20 years, both having worked for a Part B carrier and as a SHIP (State Health Insurance Program) counselor.

There are problems in all camps; beneficiaries that expect 24 hour care, providers that want the maximum payment, and Medicare not able to adequately monitor fraud.

I am on the front line of receiving calls from people all over my local area that are not just on Medicare, but are looking for medical coverage. I don’t know how we can scoff at individuals that are sick and don’t have health insurance. Why should they be denied? I talk to many people that go without their medication because they don’t have coverage, or have inadequate coverage.

I heard a national personality say on radio that because he has money, he deserves to receive better healthcare! Are you kidding me? This is a ridiculous attitude.

It seems to me that if we pool our funding sources together (Feds, States, employers, and individuals) we could develop a system similar to Medicare and provide a national system. We could still follow Medicare’s example of allowing insurance companies to provide plans that an individual could sign up with to receive their health care benefits. That way, the individual choice is there, also providing a system of competition with the plans.

I think this could be done. I sure think what we have now is unacceptable; people going without care.
Mary Belmore

I am partially satisfied with medicare. My husband and I both take many many medications. It is June and my husband is in the donut hole, he has spent what is allowed on medicare part D and has to pay the next 4300 by himself/ This is a difficult situation for many people. When I spend $600 more I will also be in the donut hole and the same pickle. Our secondary insurance is also very expensive because we wish to choose our own drs to get good care. The system need to be fixed but who know HOW
Vicky Ehringer

I myself am on medicare for a mental
disability.I have a son that has diabetes. He
really needs help financially. The cost of
strips keeps him from testing like he should.
The cost of the insulin that he should take is
to expensive, so he uses a different kind.
I don’t think it is fair because you can’t
afford insurance that you are penalized with
out of pocket money
We have had to help our son since being dia-
gnosed, which is not fair to the rest of the
family.
OH RN

NO to more Government intrusion into my life! Consider these government-run programs and their dismal track record:
Post Office founded 1775, 234 years to get it right. Even the President admitted it doesn’t work, and he cited Fed Ex and UPS as companies (not government run) where it does work.
Social Security 1935, 74 years to get it right.
Fannie Mae 1938, 71 years to get it right.
War on Poverty 1964, with $1 trillion (that’s a lot of zeros) “confiscated” and “transferred” to the poor, 45 years to get it right.
Medicare and Medicaid 1965, 44 years to get it right and they are broke.
Freddie Mac 1970, 39 years to get it right.
Recent “clunker” program this summer failed within one week with most new cars being of Japanese, not American, make = $3 billion.
Failture rate so far = $100%! Would anyone want to hand them the health care program which amounts to 20% of our GNP?
Health care needs some fixing. Let’s make changes incrementally over time to see what works best for everyone. WE CAN’T AFFORD ONE MORE BIG GOVERNMENT PROGRAM. Like those listed here, it will come back to cost us and generations to come trillions and not work. OH RN

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