<p>Cpt, I agree with you. We had a family member who was originally denied a treatment too (12 years ago), but thankfully it was not a life and death situation. The treatment was eventually paid for by our insurance company, but only after a battle.</p>
<p>
At what cost? And who pays for it? I’m not being argumentative - these are serious questions which have to be addressed under any system of health care delivery - HMO, PPO, single payer, fee for service, Medicare, whatever. As it is now, the 99 year olds with cancer are being subsidized by Northeastmom and the taxpayers - should there be absolutely no limit on the expense devoted to keeping nonagenarians alive when they’re not paying for it themselves? When they’re not even conscious in some cases? The exploding cost of Medicare and Medicaid is threatening to sink the national budget in the near future. What gets paid for and what doesn’t?</p>
<p>It’s a tough question with no easy answers.</p>
<p>Munchkin, your Canadian health care experience has been better than my friend’s was. She was not impressed. She couldn’t believe how happy one neighbor was because his bone marrow transplant was completely paid for … friend said maybe he wouldn’t have needed it if he hadn’t had to wait AGES for an MRI.</p>
<p>I do agree, though, that something must be done about our health care system. While our health care costs are nowhere near those some of you are paying, they are rising every year & we have less disposable income as a result. We are very fortunate … I can’t even imagine paying $18,000 just for the insurance (not even co-pays & medications included in that).</p>
<p>kelsmom, for what it is worth, Rxs are covered, but brand names still have a copay of $50 each. They have figured out a way to squeeze out even more money. I have a topical medication and it has a $50 copay (well, not anymore bc I now have a generic alternative, but that was not possible several mos. ago). I used to ask my doc to prescribe the largest tube so I would not get a very tiny tube for $50 and need a refill in a few weeks. Now my insurance will not allow the large tube even if their in network doctor prescribes it. They will only allow small tubes (according to my pharmacist). I will go to another pharmacist to verify the accuracy of this. Can you imagine! 18,000 and they only want me to be able to get the smallest tubes of topical ointments so that I am forced to pay more in copayments. 18k is not enough for the lousy tube!</p>
<p>We’re happy with Canadian system. Son’s Canadian 15 month stay, got him $500 worth of malaria pills-something that our family’s US- Blue medical insurance would not have done.</p>
<p>After his Canadian college (Dec 2007) we got him Blue-HSA, highest deductible, w/o vision, dental, prescriptions, and the cost is more than what he paid for in Canada for everything.</p>
<p>
</p>
<p>Not sure what you mean. Yes, if you start Social Security early, you get a reduction that lasts for life. But you get Medicare at 65 regardless of whether you’re taking SS yet or not. If you’re not, you have to write a check for your monthly Medicare premium; it doesn’t automatically come out of your SS payment, since there is none. </p>
<p>Even if you start SS at 62, you can’t get Medicare till 65.</p>
<p>Am I misunderstanding something?</p>
<p>For once I’m glad I live in NY! Insurance co’s have been barred from excluding those with pre-existing conditions since the early 90’s. And the Child Heath Plus/Family Health Plus system NYS offers makes sure that everyone can obtain affordable coverage through HMO’s which adjust their rates based on income. In fact, I have virtually identical coverage, through the same HMO, that I had in my last full-time corporate job. On an income of around $30K, I generally pay less than $50/mo for my two kids. It also covers prescriptions and dental visits, though we choose to pay out of pocket to go to a dentist we really like. I’m very careful not to abuse this system with unnecessary emergency room visits, which is what drives the Medicaid costs through the roof in our county. I believe this well-publicized program is available to all NY’ers who don’t have/can’t afford coverage through their employers, as well as small business owners, and the state strongly encourages people to take advantage of it.</p>
<p>On the high deductible note - I used to set up benefit plans for small business and often used a very high deductible policy with a side fund for reimbursement of employee medical costs up to a certain amount each year. It generally turned out much more economical, was a great benefit for the employees, and tax-deductible for the employer. Alternatively, employers sometimes chose to pay the employee premium and let the employees save in a cafeteria plan - the only downside to this was the use it or lose it provision for the employee.</p>
<p>Also, you may not realize that there are “safety nets” built into the public healthcare system that can save middle-income families from sudden catastrophic healthcare costs. They are generally unadvertised but can be of great help when all else fails. I had a situation about 10 years ago where my H’s company lapsed our family medical coverage without notifying us or offering an option to self-pay the premiums while he was recovering from a work related accident. About a month later, my D had to have emergency surgery and was hospitalized for a month due to complications…we already had a $20K hospital bill before I was notified that the insurance was invalid! We made far too much for medicaid but the hospital advised us to apply for a “spend down” through the county health dept. - specifically designed for people with unusually high medical expenses. They basically figured out an amount, based on our last 6 months income, that we could “afford” to pay (like an EFC) which was about 1/3 of the total and then the county paid the remainder. Meanwhile, I put my lawyer to work on the ERISA violation (failure to notify before terminating insurance coverage) with H’s employer. End result - employer reimbursed me and would have paid the county back too in order to avoid going to court and facing a hefty penalty. But…the county said they couldn’t accept reimbursement, even from me! I still feel bad about that, but at least we tried to make it right. It relieved soooo much stress though and enabled us to focus our energies on getting our 4 year old D healthy again!</p>
<p>
</p>
<p>I think I am lucky to a certain extent because I live in the largest city in Canada where doctors and medical facilities are concentrated. I never needed an MRI, (knock on wood), but for standard tests, cat scans, ultrasounds, bone density, all kinds of blood tests, sonograms - I had them all in the last month. There are at least 4 of these facilities within 20 minutes of where I live, and took less than 1 week to get an appointment. For a standard annual mammogram, an ultrasound is part of it, which is a more complete exam than the mamos I had in US. I read that if one does not want to wait for an MRI, you can pay a private clinic for one. Dermatology and plastic surgery for cosmetic purposes are paid out of pocket completely. </p>
<p>Drugs are not covered, and for myself, out of pocket pharmacy costs about $3000 out of pocket vs about $1000 in US. In Ontario, when we reach 65, drugs will be capped at $6.11 per prescription, after an annual deductible of $100. I am really happy about that. </p>
<p>I guess I want to write about my experience because I used to read about shortages and waiting lists and inferior standards in Canada as an argument against universal health care. So far the Canadian system worked just as well as the US system for me in terms of care. I am much less stressed about health care bills than when I was in the US. In the US, I spent a lot of time figuring out the system and trying to get the right providers to get maximum benefit at the least cost. We once had a $300 doctor’s bill denied because the insurance company(blue cross ppo) said it was not coded right - I was told they had 4 codes for ADD and would only pay for one. The doc’s office used one they won’t pay for. I spent 8 months arguing back and forth between the doc & the insurer. In the end I simply gave up and paid that bill. That’s just one eg. In addition my son has learning disabilities. I found trying to get mental health benefits was an incredibly time consuming process. </p>
<p>I hope eventually all Americans can just go to a doctor and get decent health care without spending time figuring out in plan/out of plan, deductibles, which codes are covered. The system is so complex and error prone. I can’t imagine when anyone who is seriously ill navigating such a system. Who needs it when one has enough to worry about already.</p>
<p>The CEO of Aetna - that ardent socialist - says that waiting lists for elective surgery in Canada are now shorter than for cancer surgery in the U.S., and that’s if you have insurance.</p>
<p>Walgreens, says that presciptions are down for this year. Even for senior citizens who are on Medicare D.</p>
<p>EVER WONDER WHY YOU HAVE TO FIGHT
SO HARD WITH YOUR INSURANCE COMPANY TO GET THE CARE YOU NEED? . . . . . . . . .
IT’S BECAUSE YOU’RE PAYING FOR THE SALARIES OF THE INSURANCE COMPANY EXECUTIVES</p>
<p>**ANNUAL COMPENSATION OF HEALTH INSURANCE COMPANY EXECS<a href=“2006%20and%202007%20figures”>/b</a>: </p>
<p>• Ronald A. Williams, Chair/ CEO, Aetna Inc., $23,045,834<br>
• H. Edward Hanway, Chair/ CEO, Cigna Corp, $30.16 million
• David B. Snow, Jr, Chair/ CEO, Medco Health, $21.76 million
• Michael B. MCallister, CEO, Humana Inc, $20.06 million
• Stephen J. Hemsley, CEO, UnitedHealth Group, $13,164,529<br>
• Angela F. Braly, President/ CEO, Wellpoint, $9,094,771
• Dale B. Wolf, CEO, Coventry Health Care, $20.86 million
• Jay M. Gellert, President/ CEO, Health Net, $16.65 million
• William C. Van Faasen, Chairman, Blue Cross Blue Shield of Massachusetts, **$3 million plus $16.4 **million in retirement benefits
• Charlie Baker, President/ CEO, Harvard Pilgrim Health Care, $1.5 million<br>
• James Roosevelt, Jr., CEO, Tufts Associated Health Plans, $1.3 million<br>
• Raymond McCaskey, CEO, Health Care Service Corp (Blue Cross Blue Shield), $10.3 million<br>
• Daniel P. McCartney, CEO, Healthcare Services Group, Inc, $ 1,061,513<br>
• Daniel Loepp, CEO, Blue Cross Blue Shield of Michigan, $1,657,555<br>
• Todd S. Farha, CEO, WellCare Health Plans, $5,270,825<br>
• Michael F. Neidorff, CEO, Centene Corp, $8,750,751<br>
• Daniel Loepp, CEO, Blue Cross Blue Shield of Michigan, $1,657,555<br>
• Todd S. Farha, CEO, WellCare Health Plans, **$5,270,825 **<br>
• Michael F. Neidorff, CEO, Centene Corp, $8,750,751</p>