Uninsured patients - page 2

by 15isto2

4,558 Views | 44 Comments

There has been a rather heated discussion on health inusurance and drug coverage on a disney forum I subscribe to and it got me thinking (I am from the UK so not really familiar with US health care), what happens if a patient is... Read More


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    [quote=15isto2;4529088]what happens if a patient is unisured but requires care, not thinking on "emergency" care such as major trauma but more arround cancer or long term health needs.


    One of the myths that allowed the powers in Washington cram Health Care Reform down our throats is that there are people dying from acute issues like cancer. I work with Medicaid patients. I have many patients who became enrolled in Medical Assistance because of issues like cancer. Those who truely cannot afford health insurance most likely qualify for Medicaid. Even those whose income is too high to qualify under normal circumstances would probably be eligible because of the high costs they are incurring. These folks are usually enrolled, receive treatment, then are disenrolled. Problem is that most people who have not been living in "the system" don't know how to navigate it, and aren't aware that they are entitled to assistance, and as a consequence suffer from poor health until someone comes along who can point them in the right direction. Most of the "pointing" is currently done by hospital social workers. Among my duties is to act as a liason between Medicaid and the medical community, and although I do receive an occasional referral from a doc asking for assistance in helping a patient enroll in Medicaid, most providers today simply do not understand how the system works.
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    I wish it was a myth that people die in the US for lack of health insurance. I see a patients at least a few times a week whose disease is diagnosed so late that they can't be treated, or they decide not to take Tarceva/Nexxevar/TPN/stereotactic radiosurgery/whatever because they can't afford the 20%/50%/whatever copay. Diagnoses are made too late for some people because they get "care" in the emergency room and procedures like EGD or bronchoscopies aren't done in the ER. Diagnoses are made too late because the patient is too afraid of the outpatient doctors' copay to make an appointment. Once made, all those copays for medications, appointments, hospitalizations, tests, etc are outlined and even the insured have to consider them. For an uninsured patient to be given a choice between putting down $50,000 upfront or seeking care elsewhere... .well, maybe that's one of the places where people die for lack of health insurance. If it was as easy as getting people into Medicaid or whatever other system was out there (that isn't so broke that they stop accepting applications), I'd sure like to know where to send my patients. And so would the dozens of social workers at my hospital and dozens of hospitals in my area.
    GaMBA, canoehead, Williss2, and 8 others like this.
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    I can answer your question from current personal experience! Been out of work since January due to a perfect storm of back problems. My sick time ran out in late March. To see a Dr it's $30 up front, and if I don't have it they offer to reschedule my appointment. Prescriptions also required from 20 to 45 dollars copay if the insurance company agreed with the doctor that I needed that medication. All I wanted was someone to fix me so I could get back to the ER nursing.

    15 (fifteen)! doctors later, most with multiple appointments at $30/per, I'm near bankruptcy. I've been paying for all these Dr's visits, meds, and my health insurance via COBRA ($$$) with credit cards. Borrowed money from my daughter to pay rent, eat PBJ sandwich's, no income since 1st week of April, I owe over $30,000, and Social Security has just begun giving me disability payments, 1 so far.

    I used up all my retirement savings, my wonderful coworkers have helped out, I'm now living with my daughter for free. I still hope to find a way to earn a living, but cannot do a job requiring standing, walking or lifting. The rehab doc says get a phone from home job.

    The net result is that after selling all my personal belongings, maxing out my credit cards, and the wonderful generosity of coworkers and my daughter I survived to get income from SS disability. Without all this help my life expectancy would have been only months.

    My answer to your question is that without money the healthcare system will shun you. Sorry for the verbose answer but it's been a long difficult year, and all I want is someone to fix my back so I can work. Numerous medical encounters have made it quite clear that without money, it's not their problem if I die.
    JeanettePNP, GaMBA, canoehead, and 11 others like this.
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    Sounds like some awful experiences... dthfytr you are a very strong person to go through all of that...
    This might be an ignorant question from a Canadian, but if the system is so awful with helping people in need, then why is everyone against Obama and his health care reform policies??? Is it just that the economy is so bad that people want him to focus on the making the economy better before addressing the health care system or are there just so many people out there that refuse to pay any more $$ for taxes so that everyone can have health care when needed? Our system is far from the best in Canada, especially when you look at cancer care and the expense of cancer drugs and different drugs being approved in different provinces for coverage but at least you can go to the dr and get diagnosed without paying = earlier diagnoses and better prognosis...
    TheCommuter, DogWmn, dthfytr, and 1 other like this.
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    The taxpayers pay the bill, and/or the hospital "eats" the cost.
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    Quote from AnxiousRNtobe
    I'm a social worker in Michigan. Medicaid has nothing to do with illnesses people may (or may not) have. Medicaid is for people with very low income and assets.
    That's nice that that's how things work in Michigan, but there is big variation in Medicaid eligibility and benefits among states. I am a psychiatric nurse who has done case management in my state, plus I have tried to help poor acquaintances find resources to pay for healthcare. In my state, Medicaid eligibility depends v. heavily on specific illnesses. If you are not under 18 years old, pregnant, or have one of a few specific chronic illnesses, it's basically impossible to qualify for Medicaid in my state, no matter how low your income and how limited your assets. And, AFAIK, my state is not the only state that has cut back significantly on Medicaid.
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    Quote from newrn_ptbo
    Sounds like some awful experiences... dthfytr you are a very strong person to go through all of that...
    This might be an ignorant question from a Canadian, but if the system is so awful with helping people in need, then why is everyone against Obama and his health care reform policies??? Is it just that the economy is so bad that people want him to focus on the making the economy better before addressing the health care system or are there just so many people out there that refuse to pay any more $$ for taxes so that everyone can have health care when needed? Our system is far from the best in Canada, especially when you look at cancer care and the expense of cancer drugs and different drugs being approved in different provinces for coverage but at least you can go to the dr and get diagnosed without paying = earlier diagnoses and better prognosis...
    A big part of the reason that the US could not accomplish a single payer system with the recent reform is because of FEAR...and huge doses of that were served up by some Americans, many of them who identify with the most "conservative" politics of the country. Certain segments of the general public quickly became fearful of death panels, and rationing, and never ending waiting lists, etc. Again, and in my opinion, most of that fear rested within the "conservative" members of our citizenry.

    To my thinking, that makes sense...like minded people tend to acquire information in like minded ways from similar if not the same sources. For instance, consider how motorcycle enthusiasts inform themselves...or scuba divers...just like with that, people seeking information which reflects their very conservative social and political interests read, watch, and listen to very similar, if not the same, sources. Those sources chose topics of fear and chose "personal responsibility/acountability" over "compassion".

    Honestly, I agree with Florence Nightingale - "How very little can be done under the spirit of fear". I do think we will accomplish further change, I am not sure that we have a choice...

    In essence, a portion of our society were horrified by the thought of allowing a Medicare type option to all Americans, for a fee. Visions of death panels forcing "granny" into assisted suicide or mandatory euthanasia had lots of people very nervous.
    smartin13, SharonH, RN, TheCommuter, and 4 others like this.
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    Quote from newrn_ptbo
    Sounds like some awful experiences... dthfytr you are a very strong person to go through all of that...
    This might be an ignorant question from a Canadian, but if the system is so awful with helping people in need, then why is everyone against Obama and his health care reform policies??? Is it just that the economy is so bad that people want him to focus on the making the economy better before addressing the health care system or are there just so many people out there that refuse to pay any more $$ for taxes so that everyone can have health care when needed? Our system is far from the best in Canada, especially when you look at cancer care and the expense of cancer drugs and different drugs being approved in different provinces for coverage but at least you can go to the dr and get diagnosed without paying = earlier diagnoses and better prognosis...
    From where I look at it, it just comes down to money, and confidence in the government. Insurance and drug companies make obscene profits continuously finding ways to avoid paying for members healthcare, and raise rates for those who need insurance the most so that they end up on government assistance. In essence. Health insurance is reserved for the healthy, and the medically needy (like me suddenly after working hard all my life) are priced out of the market, and the govenment has to pay to care for those sickest. Dialysis is an automatic move to government coverage, for example.
    Looking at this, our bankrupt postal service and the national debt, people conclude that government healthcare would be too expensive. In reality a single payor system covering all Americans would be cheaper because it wouldn't need to make a profit, and changing our system to this would mean only taking responsibility for the healthiest citizens. The sickest are already covered by the government. No system is perfect, but it's obscene that in the richest country in the world people die because they can't afford even basic healthcare. Our constitution guarentees the right to life and I beleive eventually somebody will tie that to the right to healthcare. Currently all men are NOT created equal, the wealthy are treated better. The classic struggle between the haves and have nots. Thanks for listening and asking. I'm surprised I made it this far because I've always been independent, and losing that has hurt very dangerously.
    GaMBA, StNeotser, TheCommuter, and 7 others like this.
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    wow. good question 15isto2. i don't really understand america's health system either, but this has definitely given me a great insight into it. honestly i'm quite amazed at it all. no offence to any one here but i have to say i'm pretty glad i live in australia.
    happy2learn, DogWmn, and dthfytr like this.
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    Quote from sassy_squirrel
    wow. good question 15isto2. i don't really understand america's health system either, but this has definitely given me a great insight into it. honestly i'm quite amazed at it all. no offence to any one here but i have to say i'm pretty glad i live in australia.
    see if this helps you to understand.

    competition is supposed to drive prices down and quality up through supply and demand. the insurance companies are loosely regulated by the states, and so competition doesn't really exist. there are only a few health insurance providers in each state, and consumers are not allowed to buy health insurance across state lines.

    the insurance companies exist to make a profit, like any other business, but without the pressure of competition. this leaves the insurance companies free to "cherry pick" their customers. they insure healthy people and dump sick people, who must then get government assistance (which isn't easy or luxurious), or they just go without health care altogether.

    american health insurance companies are hugely profitable, since they avoid insuring sick people. government health care is a huge drain on taxes since it must care for all the people who are chronically ill and rejected by health insurance companies.

    so, in america, money talks and is now more important than life, an equation i find vulgar. but since insurance companies have millions of dollars to influence government policy, the wealthy are protected, and poor are shafted
    StNeotser, tewdles, nursej22, and 1 other like this.


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