Public option vs private insurance, my own story

[PatSeg]

I am going to try to tell my story as clearly as I can.

I experienced our current health care system from three totally different vantage points, though the illness was always the same. I saw it from:

A. Being insured with top-of-the-line insurance coverage.

B. Being unemployed/uninsured as such categorized as "indigent".

C. Medicare recipient

We moved to California at the end of 2001. I hadn't had any medical treatment for over 25 years, but evidently I was extremely sensitive to the air quality in Sacramento. After a few years I started to have breathing problems and ended up in the emergency room unable to breathe. I was treated and released and my nightmare began.

I had good GOOD insurance and could afford my medication. There were frequent visits thereafter to the ER and a lot of frustration when I was released was from the ER feeling just as badly when I went in as when I left. One time I got to the car, ready to go back in, wondering why they didn't admit me. I know now that the fight with the insurance company was a primary consideration. As a result, I ended up in the ER over and over again.

After many ER visits, I was admitted to one of the best hospitals in the area. The young hot-shot doctor put me on every medication available, determined for some reason to release me as soon as possible. The medication changed daily and the nurses, as well as my family were concerned that he was trying to release me too quickly, as I was in terrible shape. Fortunately a very knowledgeable and understanding nurse fudged some numbers, which kept me in the hospital another day.

I was released and the the ever-changing medications were different when I left. I had been given mega doses of medication I'd never been on before with total disregard with my susceptibility to blood clots.I went home and was up until 5 in the morning with my heart pounding. The next day I was back in an ambulance to a another hospital with blood clots.

Emergency surgery followed and I was in the hospital for a week. Had the former doctor been paying attention to my medical history, this probably wouldn't have happened.

During this time there were MANY out-of-pocket expenses that had to go onto credit cards, thousand of dollars and I will soon be filing bankruptcy because of it.

Time passed and I lost my job, as well as my insurance. The Iowa Caucuses came and went, and we experienced some horrific forest fires here in CA. We went for long periods of time where we couldn't see the sun AND I couldn't breathe.

In March of 2008 I ended up in an ambulance yet again, but this time things were different. I was officially classified as "indigent", but somehow I was admitted quickly and easily to the hospital. People came to my hospital room and helped me with all the necessary paperwork for medical assistance. I saw doctors frequently and I never had to lift a finger to work out the financial details. Someone came in and did all the paperwork for me. What the HELL was going on. I never got this kind of treatment when I was insured by one of the biggest insurance companies in the country. In the beginning the county paid for pretty much everything and the doctors were free to just be doctors. One could sense the relief that they didn't have to justify every decision to an insurance company.

When I went home, it was planned that oxygen would be available at the same time. If they gave us any problem, we were to give the phone number of the woman who helped me in the hospital.

Medicaid took over nine months to kick in and it only covered expenses after the first $875 a month, so I pretty much had to pay for a lot of prescription medication on my own.

Through all this I found it interesting that I seemed to get BETTER medical care without insurance than I did with it.

Unfortunately thoughout all this I never really got well. I got better for periods of time, but the condition itself was always there and I was limited as to how much medical care I could pursue.

Last December was a major turning point in my life. Another frantic rush in an ambulance to the hospital and much of it is a blur for me. I have few memories of the experience as I ended up in the ICU and they gave me huge amounts of "milk of amnesia". I only know what people have told me. I do know they saved my life, but I never talked to a doctor. I am so grateful for what they did to save my life.

After four days in the ICU, I went into a private room and then was released with no pain management program and no consultation with a doctor. My daughter was a basket-case and my son was 3000 miles away. I went home without any clear idea what all had happened. I was still very sick and could not leave the house for weeks.

I went back to my doctor, who I adore. Once again he prescribed the same medication he had prescribed years ago. When I was insured, the steroid inhaler was expensive - $75 and with insurance $25. A year ago the medication had gone up to $143.00. I just couldn't afford it. Now it was $250.00! I just tried to stretch what I had left.

Being I never fully recovered from December, I ended up back in the hospital in February. February 1st Medicare kicked in for me. I planned this trip carefully. I couldn't handle another panic-stricken ambulance ride to the hospital. I had taken the steroids and a few hours later we drove to the hospital and I was able to WALK into the hospital.

So now we're at Part C of my medical story. They tell me they want to admit me and a doctor comes and asks me about my insurance. I tell him I have "Medicare" and he says something to the effect of, "No problem, you're good to go." Everything, everything was SO different at that point. I had a Public Option and it was like a red carpet.

I am better now, MUCH, MUCH better. I saw a doctor one or two times a day and on the fourth day a doctor actually asked me if I wanted to stay another day!!!! I immediately said "yes". As much as I wanted to go home, experience had shown me what a difference a day or two made. No one had EVER asked me that me before.

So I went home and my daughter went to fill the prescriptions. The steroid inhaler was now $250.00 and it cost me $3.33. $600.00 of medications cost me less than $40.00. It has made such a huge difference. I went weeks without ever leaving the house because I was so ill. Now I've gone out several times a week for hours and I am fine.

My children have been through hell and that has been the biggest toll for me. I cannot believe what a huge difference Medicare was for me. With high-end insurance I got decent care, as an "indigent" I got better care, and with with Medicare, I got extraordinary care. What does that tell you?

We need a public option and we need it NOW!

[wroberts189]

1. knr to your op... is it possible to move to a place with cleaner air? nt

[PatSeg]

2. Thank you

Not at this time, but being able to actually afford my medication has made a huge difference.

I have experienced tremendous empathy for those who are affected by our health care issues. I wanted to share my own story, as there is a big difference between understanding it intellectually and actually living it. I am truly humbled by own experience.

[wroberts189]

7. No... Thank *you*... here is my own little story...

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=7813516&mesg_id=7817217

[PatSeg]

9. That is insane

I guess most of the stories we hear are though. Insurance and health care are a bad combination. We get insurance for unforeseen hazards like fires and accidents. Health care is an ongoing part of life, not an accident.

[gateley]

13. Well put. Therein lies the difference. nt

[cutlassmama]

3. thanks for posting your story. Glad to hear you are better

[PatSeg]

4. Thanks

It is so personal and it took me weeks to post. I just needed for people to understand the huge difference between private insurance and a Public Insurance.

[Lasher]

5. Do you have Medicare Advantage (AKA Part C) or traditional Medicare?

And BTW, thanks for the contribution.

[PatSeg]

8. You're welcome

I have traditional Medicare. When I lost my job and got sick, I went on Social Security, so my financial situation gave me an edge with Medicare. Until I used it, I had no idea what an incredible program it was. I understood intellectually what a "public option" meant to people, but living it is a different story. When I had the "good" insurance, I paid thousands of dollars out-of-pocket for deductibles, co-pays, etc.

[Lasher]

11. OK it helps to know that.

And since Medicare Advantage is for profit I wonder if the experiences of others would be similar to yours under the "good" insurance. My "good" retiree medical premium increased quite a bit in January, and today I had to caugh up a $160 copay that I wouldn't have had to pay last year.

[PatSeg]

12. I really don't like the fact that

"for profit" companies are involved in Medicare. They often look at any government program as another give away, very sleazy and I don't trust them.

I was particularly impressed with how well run Medicare is. I had dreaded it, thinking all government programs are complicated and inefficient. Not so with Medicare. I was automatically signed up for a premium-free drug program that I could opt out of if I wanted a different plan. Medicare has an excellent website where you can compare the different plans based on your own needs. This wasn't what I was expecting.

[Lugnut]

18. I have a Medicare Advantage plan.

It does not work as well as trasitional Medicare. The advantages of a Med Avantage plan is it provides at least basic coverage for dental and eyeglasses along with prescription coverage. Medicare does not.

With MA there are provider lists, copays, "coinsurance" meaning out of your pocket and the dental coverage is just the very basic. Premiums for MA plans are significantly lower than a traditional Medicare supplemental plan. My monthly premium for 2009 was $106 but it's now $138. The Medicare premium did not go up because there was no Social Security COLA for 2010.

[Lasher]

20. Thanks. I was hoping someone just like you would weigh in.

Medicare Advantage was initially conceived so that insurance companies could compete on a level playing field with traditional Medicare. The efficiencies of the private sector would drive down costs while providing enhancements to beneficiaries, or so the theory went. The problem was, this ideology was not consistent with reality.

These companies couldn’t compete with traditional Parts A & B. The Bush administration and his GOP lapdog Congress came to their rescue by authorizing a Medicare Advantage per-capita subsidy that is 14% greater than the one going to traditional Medicare. We are left to wonder how much of this additional 14% is being used to fatten insurance company profits, and how much is being used to enhance participants’ benefits.

I don't blame you for buying into Medicare Advantage for the dental and vision benefits. But it needs to be shut down and hopefully we will see that soon.

http://www.ncpssm.org/news/archive/vp_medicare_advantage/

[PatSeg]

22. We posted at the same time

Thanks for the information. Your facts confirm my suspicions. I don't trust anything that involves private insurance these days and there was a time when they were respected and reputable (long, long ago). At that time it was large hospitals and some greedy doctors who took advantage of insurance companies and started over charging for procedures, even charging for services not provided. The patient didn't have a clue what was going on.

[Lugnut]

25. It's a gold mine for insurance companies.

I'd gladly use traditional Medicare if it provided better overall coverage. My eyes and my teeth are part of my body. I've never understood why health care for those parts need separate coverage.

[PatSeg]

27. It seems to me

that the government money going to these insurance companies would be better spent expanding traditional Medicare to include dental and eyeglasses. And if the government could negotiate drug prices, that is more money that could be spent on health care, rather than huge profits for big pharma.

[Lugnut]

31. I couldn't agree more.

Unfortunately, our Congress critters don't listen to us.

[PatSeg]

33. Back in the day,

I couldn't stand LBJ because of the Vietnam War, but damn that man could get stuff through Congress. So these days, I have to admit that I am truly grateful for the good things he did, especially Medicare. He still doesn't get a pass on the war though.

[PatSeg]

21. Over the past year

I got bombarded with Medicare Advantage advertising. I got a disturbing image of company executives gleefully rubbing their hands together, "Free government money! Yay, we've hit the jackpot." They probably call it Medicare "Advantage", because every greedy bastard out there will try to take "advantage" of it and its recipients.

I also notice that attitude in advertising for various medical devices - "Don't worry about it. We'll file all the paperwork and if Medicare doesn't cover it, it's free." Everyone wants to get on the gravy train.

[Lugnut]

24. The advantage to me is very small.

It saves me a lot of money paying for the extra coverage Medicare doesn't provide. Dental bills and paying for eyeglasses are simply unaffordable for me. My insurance company is way ahead of the game because, in spite of having incomplete spinal cord injury, I'm fairly healthy. The three prescriptions I use are all generic and I rarely need to see my PCP more frequently than every six months. I haven't yet had to test my coverage so it could prove to be eye opening.

[PatSeg]

29. I'm so glad you haven't had to test your coverage

and hopefully never will. We may live to see the day when private insurance no longer has so much control over people's medical care. I'd like to see them gone completely, but don't expect that to happen in my lifetime.

Meanwhile, I think my health is now manageable. Affordable prescriptions will make a huge difference in my case and save everyone tons of money.

[Lugnut]

30. Insurance companies add nothing of value to the process.

I think Medicare is proof of that fact. My thoughts though go to all the jobs insurance companies provide to people like me. With jobs so hard to come by these days eliminating more of them is out of the question.

Thank goodness you're at a point where your health is more manageable as well as more affordable. :hug:

[PatSeg]

32. That is true about the jobs,

but if private insurance companies went away, it would be very gradual so it probably wouldn't impact the job market. Besides these insurance companies are very resourceful. I'm sure they'll find another racket really fast.

Thank you, I want to see everyone's health both manageable and affordable. It might take a while, so I have to live to be pretty darn old!

[mmonk]

6. Thanks for posting this PatSeg. Recommended.

[Echo In Light]

10. K&R

[gateley]

14. I wish every person who is hanging on to the belief that for-profit health

insurance ensures us "the best health care in the world" could read this. Good job, Pat! I didn't know anything about Medicare until you'd mentioned that it LITERALLY saved your life!

Had you still been with that big insurer, who knows?

Something that jumped out at me -- Medicaid only kicked in after $875 a month??? People on unemployment barely make that! Something needs to be done about that program, too!

I am so happy you FINALLY got the care you needed, from this stinking socialist government! :7

:pals:

[PatSeg]

16. I said to my daughter tonight,

that those people who want to keep their private insurance plans, probably never had to use it for anything other than office visits and an occasional prescription. One hospital stay will quickly change their minds when they see the bills come in that the insurance doesn't cover.

As for the Medicaid, I'm allowed to make about $650.00 a month. Guess anything over that is considered gravy.

To think I stayed at a really sucky, poor paying job just to keep that GREAT insurance!

[CrispyQ]

19. I think this is a key problem.

Too many people who have great insurance have never really put that great insurance to test. Until they do, they will continue to think that they have access to the best medical care in the world, simply because they have great insurance. Health care, like the economy, seems to depend on people experiencing the downside personally before they wake up to the travesty & perversion that has become a way of life for too many Americans. How do we reach such isolated & hardened individuals? Or will we have to wait until many, many more people are feeling the pain?

Thank you so much for sharing your experience with us Pat. Have you considered submitting it to your local paper? Sometimes they have guest columns where they allow much longer submissions than the regular LTTE section. Then again, you might not feel like defending your point against the numerous mindless teabaggers that are sure to write in, denouncing you & a socialist medical system. :eyes:

I'm so glad you are doing better! Be well, my friend! :hug:

[PatSeg]

23. Yes, it is really sad

that there are people who only learn from personal experience. They have a "we and them" mentality instead of a "there but for fortune go you or I". Ironically, when they are hit by misfortune, they are the ones who scream the loudest about the injustice that has befallen them and are quick to turn to the government for help.

Are people born with a compassion deficiency or do they learn it? It is so sad, as a health crisis can hit anyone and except for the super wealthy, anyone's life can be destroyed by one major illness. We are all in the same boat and the enemy isn't the guy next door who lost his job and health insurance at the same time his wife was fighting cancer.

I love my local paper, but the readers responses here are often down right nasty. Its a bit too close to home for me.

[jillan]

15. Pat - thank you for sharing your story!!

How crazy it is that you got better care when you didn't have insurance than when you did.

I'm so happy you are better now. That is also crazy about the cost of the drugs.


Have you posted your story at WH.gov. Our President should read this.

[PatSeg]

17. I know

It was amazing to see the change in doctors' facial expressions and body language when they found out I had Medicare. You'd think I was royalty.

I haven't posted my story at WH.gov. Good idea, thanks.

[Hell Hath No Fury]

26. Thank you for your story!

My Mom is on Medicare (plus some really good gap coverage) and her experience is much like yours -- she is treated extremely well and doesn't have to worry about much.

I, too, have been on good private insurance and San Francisco low income city coverage. When I was getting my treatments at SF General Hospital, I got really great care -- I would not hesitate to go back to it in an instant.

You said something that is VERY important:

With these types of p[rograms vs. for profit insurane, the doctors and nurses are free to just do their jobs. No fights with insurance officials, no refusing of tests or procedures to satisfy soem bean counter. Just doing what they trained to do -- practice medicine.

[PatSeg]

28. I've seen the frustration

from good doctors when they can't treat patients the way they were trained to. Their faces really light up when they know their hands aren't tied and they really have an opportunity to help someone get well.