Saturday, November 16, 2013

Health Care Joy!

So, you know how, in your life, there is some institution or bureaucracy or just dumb asses congregating in one location that appear to be created to make your life more difficult? And for those of you shaking your heads, “Why No. Whatever do you mean?” Let me just say Division of Motor Vehicles.  And if that doesn’t illicit some sympathetic realization, I’ll say Internal Revenue Service.

See?  Most of the head shakers are now head nodders.

The bane of my existence as a case manager is how miniscule the understanding of the American Public is about Medicare provisions and regulations.

I am going to bet if you read my blog you are familiar with some of the big questions of coverage. A little quiz, just see if you were paying attention.

What is covered and what is not?
1 - In home aid care for incontinence?
2 - Assignment of a case manager to assist with provider access and care coordination?

3 - Medical transportation to physician’s appointments and to pharmacies?

4 - Ongoing physical therapy until a level of functioning and self-care is achieved?

4- Long Term Care in a Facility when remaining at home would create unacceptable risks?

5 - Payment for eye glasses, dentures and/or hearing aids?

6 - Prescription medications in amounts ordered and monitored by a physician?

7 - Instillation of bathroom grab bars to prevent falls?

The answer to each of these questions is . . . nope, not a chance, absolutely no way, that’s a negative, never going to happen and Soylent Green is people!

So here is the thing, if you have never had to consider these aspects of healthcare (or lack of healthcare is probably more apt) and you went on your blissful way, fully assuming that when the need came, mom would be placed lovingly in a cottage-like private room, a view of rolling hills and bunnies out the window AND her nest egg would pass on to you without difficulty, may I gently remind you that providing adequate care in long term situations is something our rugged individualism rallied against. 

“No damn government is going to tell my momma what to do! Keep your government paws off the Medicare and we will be just fine!”

“Do we really owe anything to those Americans who were too stupid to stay young forever or who were dumb enough to be born with a life threatening disease?  Silly people. That is NOT how the American dream works!”

Lately, because it is that time of year, it has been the “donut hole” causing complete melt downs. (For those of you who are familiar with the donut hole, you see my conundrum in explaining this genius piece of legislation?)

A long, long time ago, (about the time that Noah was trying to push the last of the dinosaurs onto the ark) Medicare did not cover prescription medications. If you could afford the premium, you could get an entirely different medication policy and if you couldn’t afford the premium then you sure couldn’t afford the entire cost of medications.  And face it, Wall Street had you labeled as a societal drain and being that poor you couldn’t possibly have wanted to go on living anyway.

But then our buddies at the pharmaceutical agencies said, “There are entirely too many old people not taking our medication!”  How unfair to the bottom line and Medicare part D became a reality in 2006. So the super fun part of Medicare part D is it helps pay for medication for a while and then it says, “Well that’s enough of that and you are on your own.”  Then, if you spend enough out of pocket, Part D grumbles, “Well I guess you really are sick and the longer we can help you live, the more medication you will buy.” (Or something along those lines.)

Today the son of one of my guys lost his mind. Medicare is not going to pay for assistive devices in the bathroom, nor will it pay for physical therapy to come to the house indefinitely. It does not pay for incontinent supplies, emergency response systems or home renovations.  It does not pay for laser hair treatments, puppy neutering or removal of head from own ass. But when he really lost it was learning about the “donut hole.”

He appears to have  the irrational belief that I, personally, by myself, sans all other cognizant creatures, went to the Federal Capital Building and demanded a special mandatory session. Then I was whisked to the podium, where my vastly superior powers of speech conned all present to vote for the donut hole.

By the time I retire, the donut hole will probably be the least of our problems. I’m guessing the entire system will be bankrupt and run by malicious chimpanzees.  Access to hospital placement will be determined by lottery and by “hospital” I mean a cardboard conglomeration, duct taped together with a red cross colored on the front. Then we will wish the biggest issue with medical care was the donut hole.   


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