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Liz Peek | 09/16/2009 12:25 pm

Liz Peek: The Inefficiencies of Medicare … Your Personal Stories Needed

Correcting the most egregious inefficiencies of the system would be a giant step toward bringing our ballooning health-care payments under control. Why not give the president some help?
© Shutterstock
Editor’s Note: Liz Peek is a financial columnist and author of wOw’s Wall Street Weekly.

One of the oddest elements of President Obama’s relentless health-care pitch is his inability to provide convincing examples of how he is going to save money and where he can cut Medicare. Normally, when you’re trying to win over an audience, you migrate from generalities to specifics to strengthen your argument – and to make it more accessible. Since the president is correctly credited with being a master orator, his unwillingness to shell out real-life examples of how he can cut $500 billion from Medicare and not reduce treatment makes many of us skeptical.

Here is how President Obama can become more convincing overnight, and how you can help him do that. wOw readers can provide the concrete examples that he needs to make his case. There must be many among us who are on Medicare, or who have relatives on Medicare, and most likely a large number have come face-to-face with the inefficiencies – to use a polite word – of this vast government program. Let’s pool our stories, and see if there are indeed obvious instances where existing policy wastes money.

Here’s a "for instance": The other night I heard a horrifying story from a friend who is on Medicare. She had gone to her doctor that day to get a prescription for a nasal spray to combat allergies. Earlier, her physician had given her a trial sample of the medicine to see if it was effective, and it was. Instead of giving my friend the expected six-month prescription, the doctor wrote instructions that would provide only one month of treatment. It quickly became clear, through questioning, that the doctor wanted my friend to return monthly for her medicine because Medicare would pay for repeated (unnecessary) office visits. Reimbursement, in other words, had nothing to do with effective treatment and everything to do with bean counting. Bottom line? The doctor stood to make a lot more money.

This is the kind of nonsense that gets us grinding our teeth and could bolster President Obama’s promise to extract $500 billion from Medicare without impacting treatment. I still think it would make much more sense to tackle such problems with Medicare immediately and that changes in our insurance industry need not be tied to such reforms, but at least it gives me some confidence that there are indeed costs to be curbed. I would also add that I consider such evidence of "waste and fraud" in government-run programs powerful arguments against expanding federal involvement in the health-care industry.

Still, it would be very interesting to hear other such anecdotal evidence of Medicare inefficiencies. Such stupidities do not necessarily constitute fraud – they are simply the result of the medical profession gaming a system that relies not on judgment but on bureaucracy. It should be noted that many doctors may be forced to do so since they may not be adequately reimbursed for treating Medicare or Medicaid patients. But correcting the most egregious inefficiencies of the system would be a giant step toward bringing our ballooning health-care payments under control. Why not give the president some help? Please contribute some of your own observations about Medicare or other government-sponsored health-care programs. Let’s have a wOw voice in this debate!

99 Reader Comments (so far…) Sign In or Register to comment

Sandy B

My father worked many years at the same engineering firm and retired with EXCELLENT insurance.  Which unfortunately, has been repeatedly swapped down to worse and worse coverage including obstructionist behavior through a major illness of my mothers with an absolute jack-ass of a Dr. who clearly was angling for his bonus by not ordering too many tests for her- though they were clearly needed (hmmmm….sounds like RATIONING). 

I honestly don’t know exactly how this works but she dumped what was once her excellent coverage- and is very happy with Medicare.

By Sandy B on 09/16/2009 11:44 am
Kathleen Vignolini

Ditto! My Mom was on Medicare for years. It helped keep her healthy. She also had a supplemental Govt. Employee Insurance, which ONLY covered items that Medicare paid for first (& didn’t pay when Medicare didn’t)!

When she had a stroke, Medicare paid for rehab, though the "doctors" thought she’d never regain her "independence" again. Medicare paid for her tests, hospital, equipment, etc. After the third rehab (the ONLY place I’d say defrauded Medicare & I  reported them), she had to go into a Nursing home. Before going on Medicaid, she (I) had to spend ALL of her lifetime savings & income (SSI & Govt. Pension), drop her Insurance plan to a mere $1500, and be reduced to abject poverty, thanks to Reagan’s cuts to Medicare / Medicaid.

A lawyer, specializing in "elder law" told us that if she had more money saved, "she could hide it by buying cars, jewelry, furs, etc." Instead he suggested what we should do, "Make sure you have enough to care for her in the nursing home, till Medicaid kicks in." My Mom worked all her life and saved so she didn’t have to be a burden on her children, and would have something to leave for them. That didn’t happen, in great part due to the severe restrictions put onto Medicare / Medicaid, and in part due to the unjust estate & tax evasion laws that favor the wealthy.

So, Please get the facts straight. Stop pointing to the "fraud" of Medicare / Medicaid, and start looking for the fraud that those who can "hide their assets" use to avoid taxes & push their medical costs on the rest of us.

Kathleen E Lo Pinto VIgnolini

 

By Kathleen Vignolini on 09/18/2009 1:23 pm
Laura Ward

My friend recently completed an 18-month rehab program. Her diagnosis was being bi-polar and deep depression. She’s also an alcoholic. She’s on disability $1,144 and has a part-time job where she makes $400 a month. She’s trying to find permanent work. She can’t find a psychiatrist who takes Medicare to prescribe the drugs she used to take to control her mood swings. So she’s bravely trying to keep calm at home without drugs and do whatever it takes so that she doesn’t relapse. There’s a service here called Mental Health and Mental Retardation Authority of Harris (Houston, TX) County which could give her the counseling and drugs, but they say she makes too much money to qualify. She can’t get food stamps either, again, because she makes too much money and doesn’t have dependent children. Even if she quit her job, she’d still make too much money for either.

Yesterday, she went to the dentist because of an infection in her gums. Apparently, she has an abscess which if she doesn’t take care of it could go to her brain and kill her. Since I was there too, and since my boyfriend goes to this dentist, this dentist who appreciated the business from my friend for years when she used to have money and the referrals from us, only charged $27 for the $87 service. The dentist prescribed antibiotics and pain pills, but the tooth will need to be extracted and my friend has no money for that. She has an appointment on October 29th at Ben Taub to extract the tooth where they take Medicare. We hope the antibiotics and pain pills help her for the six-week wait.

She’s not happy with Medicare because she has a hard time finding doctors that take Medicare. Maybe once she finds a doctor, she’ll be happier about it. In the meantime, she ends up at the public hospital every time where it takes a long time to get appointments, and then once you get the appointment, you spend all day before they see you.

By Laura Ward on 09/16/2009 11:54 am
Mel Berg
Laura, is your friend on Medicare or Medicaid? I have not heard of anyone having a hard time finding doctors on Medicare, but I have heard that about Medicaid.
By Mel Berg on 09/16/2009 4:11 pm
Laura Ward

Oops, I better find out which one or I’m going to be like Emily Litella…never mind.

(thanks for pointing this out because I thought both offered the same services)

By Laura Ward on 09/16/2009 5:35 pm
Christine Cline

Yes, they are different; but, they both come out of the same pot. This is just one more ineffeciency of Medicaid. They have three different medical programs depending on whether the person is on Social Security, SSI, SSD or straight Welfare.

Hope this helps you.

By Christine Cline on 09/16/2009 8:21 pm
Laura Ward

Thanks, I really was feeling like Emily Litella where I’m confusing the two programs. My friend finds her Gold Card more useful than Medicaid (unless the Gold Card in Houston, TX is related to Medicaid—I’m getting confused). I know she applied for social security disability insurance and SSI but got the disability because of her mental illness diagnosis. I also know disability pays more than SSI because the SSI was approved first, so she got that money first, but the disability was approved almost immediately after, and got that money just a week later. Frankly, I thought SSI was welfare. I guess it’s not according to your post. Thanks for your info!

By Laura Ward on 09/16/2009 9:47 pm
Christine Cline
Actually there are four types of welfare. Social Security, SSI, SSD and straight Welfare which may have different names in different states, I’m not sure. Here in Iowa it’s called FIP for Family Investment Program (what a joke). Because I get SSI I also get Welfare (a whopping $183.00 a month) for my granddaughter. Most people only see Welfare as welfare because it is considered unearned. Though how striving to care for one’s home and children can be considered worthless is beyond me. Welfare comprises a mix of people, including those fleeing abusive situations and those that are disabled but too poor to get the medical care and diagnoses needed to qualify for SSD or SSI. But in the end they are all welfare because they are all paid for by the grace of the tax payers.
By Christine Cline on 09/16/2009 10:09 pm
Laura Ward

The sad thing about this system is that my friend is now desperately trying to get off her disability insurance. She is capable of working a full-time job provided it’s not full of stress (remember, her mental illness diagnosis provided her with an income, but that income means she now makes too much money and falls into an area of income ineligibility where she can’t get the drugs to help control her mood swings—somehow, this doesn’t make sense). But in this economy, she’s having trouble finding a job. I don’t have her mental problems and I’m unemployed too and having trouble finding permanent work too. She gets some comfort from that. Of course, there’s plenty of temporary work with no health insurance. The lowest we will go is permanent work and we pay for our health insurance.

I sure hope someone from wowowow is using what we are saying and this information gets to someone where something can be done. I would think it’s especially important since we’re from different states. Iowa and Texas.

By Laura Ward on 09/16/2009 10:36 pm
SURA B
NONSENSE!!!!!
By SURA B on 09/17/2009 10:22 pm
C jay
Check on your definitions of "welfare" Christine Cline.
By C jay on 09/18/2009 7:21 am
Christine Cline

The Random House Dictionary of the English Language: 4. on welfare receiving financial aid from the government or from a private organization because of hardship and need.

Therefore any money received for the purpose of survival is considered welfare. People prefer to seperate Welfare from Social Security, SSD, and SSI because Welfare is considered an unearned and meanly gained income, while the other three are considered earned and therefore acceptable. True there are people who are lazy, unambitious and financially uneducated enough to be content with Welfare. But many women on Welfare are domestic violence refugees of which financial abuse is always a part of  to keep the woman from having the means to leave. My husband was abusive. Though I stayed as long as I was the only one abused because I knew the price of accepting Welare was much higher than what he could dish out. Now my children was a different story. The minute I knew he was laying a hand on my child (sexually abusing her) I was out the door. I would face a whole society of abusers to keep my children safe. And so I have. Most people are anything but kind to women on Welfare. Some women on Welfare are disabled but unable to get to the doctor to get the proof needed to qualify for SSD or SSI. I also faced that issue when I left my husband.  

So you see it is not welfare that is defined wrongly; rather, it is the individual people on it that are seen not as the individuals they are and treated accordingly. Welfare people are judged as a bad stereotypical group while the other three groups of people are seen as individuals and gotten to be known first and then judged. I know the person I am because of that I could just tell people that I am disabled and on SSI which would instantly upgrade me in their eyes; but, I prefer to tell them I am on Welfrare. I wish to be judged honestly and I want people to see that not all Welfare people are bad.

By Christine Cline on 09/18/2009 7:59 am
C jay

Absolutely, and … the best care in America is in public hospitals. Yes, there may be a wait, but NOT if care is imminently needed. No one personally benefits in a public/county hospital, period. Doctors are salaried, like everyone else. There’s a great misunderstanding about medicine in the U.S. and there always has been.

Truth is no dental care is given to anyone unless they are children on Medicaid, and then it’s scarce, at best. The DDS do not have to donate time, nor do they as a general rule. Their M.O. is PROFIT, period. I’ve spent years trying to find dental care for people, yet that is the orgin of our health to a great extent - the mouth, teeth, and gums. Some communities have a dental clinic, and they do usually, have a 3 month wait to get it, but it’s worth it to get signed up and wait it out. Prophylaxis is crucially important, too - some university-based hygenist programs take the public, and from there, if there’s a dental problem, they often have contacts for people with the rare caring DDS in the area.

If anyone is on Medicare and/or Medicaid and cannot be seen locally, contacting their state department of Health and Human Services will bring a response. NEVER SUFFER IN SILENCE.

 

By C jay on 09/18/2009 5:47 am
Christine Cline
Here in C B, Iowa adults and children on Title 19 (Medipass) and Medicaid get dental care. We can go for checkups and teeth cleaning twice a year. We can get fillings and if considered necessary according to Medipass’s or Medicaid’s idea of necessary get braces. I use only organic toothpaste and avoid flouride and therefore have perfect teeth so I leave the checkups to someone else more needy.
By Christine Cline on 09/18/2009 8:04 am
Lynne Hanson

Here in Alaska (Anchorage) primary care physicians are opting out of Medicare - which leaves a whole bunch of folks over 65 without a primary care physician.  Truly - folks are actually ‘fired’ by their docs.  The physicians claim that medicare pays for only 40% of the bill for seniors.  My own doc says this is really just the tip of the iceberg when it comes to Medicare (he also says that his $400,000 take-home pay isn’t enough). 

By Lynne Hanson on 10/09/2009 8:38 am