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.
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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?
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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?)
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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.”
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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