Friday, July 24, 2009

Mr. Obama's so called health care...

First - I have got to say how thankful I am for each of you and for the comments you leave for me when I post. When Schnitzel and Trout were here, it truly made me realize that you have let me be part of your lives and I NEVER EVER want to take that for granted. SOOOO, I hope you understand that when I write about things like this, its not to change your mind or devalue your opinion - its because there are things I either don't understand and need to research OR its because something slaps me in the face as being COMPLETELY insane, ridiculous or down right wrong. So goes this current nonhealth plan.

First - I worked as a W-2 worker in our great state for 7 years. If you are not familiar with W2 look it up. Its called Wisconsin Works - don't be fooled, its still welfare but under a different name. Anyway - W2 itself is not the only assistance programs there are. Medical Assistance, from now on will be referred to as MA - is also a part of public assistance in general. To qualify for public assistance you have to meet certain criteria for each program to be eligible for said program. For MA - there were 17 different categories you could fall into - you had to either have children or be disable and/or elderly. The income limits for these programs were VERY low when I first started, but Wisconsin was in the middle of revamping our whole welfare system - thank you Tommy Thompson - when I first started and the state was billed by the doctor/hospital or clinic directly. At that time each facility had its own billing dept and certain people would handle the MA billing - most facilities are still this way (Willow Witch - any insight on this would be great - thank you) Soooo the clinic/facility would bill the state directly. When billing for MA there are certain codes that need to be used so that the $$ is ear tagged and they know how much $$ was spent on what illness's etc. MA coding is a big deal, HOWEVER, the state had specialists to help the clinic or facility if they were not coding correctly. It was a good system and it WORKED well - very cost effective with little issue about payment. Fast forward about 8mo into my work as a W-2 specialist- enter HMO's, or in other words - come on in and lets throw money into a bottomless pit so we can raise taxes, get poor service, have chaos in billing and payment practices and basically spend $$ NEEDLESSLY!! Before HMO's were allowed into the MA world you had direct bill - direct pay... so if you had a $300 bill from the doctor it was billed to the state and the state payed $300 simple right - right. So if the next month you didn't have any medical expenses the state paid nothing.... sound good so far? WELL, when the HMO's were allowed to come into the picture this is what happened, I hope you can follow this....its kind of confusing. The HMO's would 'facilitate' the billing/payment process of MA but to do this each person on MA had to be enrolled in the HMO and the state had to pay the HMO for EACH PERSON that was enrolled in it. getting this so far? Not only did they have to then pay for the service that was provided they had to pay for the HMO to 'handle' the billing for each recipient. The state had to pay for the MA recipient EACH MONTH regardless if they used the MA or not. The state has to pay on an average of $150 PER PERSON PER MONTH - whether they went to the dr. or not.... stupid huh? That 'premium' is on a sliding scale, but that is the 'average' - so a family of 4 cost the state $600 per month whether they went to the dr or not.... now how dumb is that???? There were no jobs lost or gained in the process of allowing HMO's into the scheme of things - it was purely for the benefit of HMO's - friends of politicians... Wisconsin had 5,900,000 people in it and in 2004 there were 800,000 people on MA JUST IN WISCONSIN.... so for 1 month of HMO premiums the state paid $120,000,000 - for the year it was $1,441,000,000 - from one state...... Now it could be more, but it wont be less. People that are ill more often or have chronic issues its more - but for people who never or rarely use it - it is still paid.... Fee for service worked and saved SO MUCH BETTER. The HMO's argue that people were abusing the 'system' because they were going from one dr. to the next or going to the ER more than needed... well - I really doubt that they were spending $120,000,000 per month of frivolous medical expenses.. how does this equate into the current nonhealth agenda - well, it would just be on a bigger scale.

Secondly, in the new nonhealth care plan - people who have chronic illness could be REFUSED treatment because it was/is not cost effective. Excuse me? I pay taxes and you will not give me the health care I am paying for? Also, if you are over 59 you will not be allowed to have heart stents, open heart surgery etc because its not 'cost effective' - Tom Daschel stated and I quote
"health-care reform will not be pain free. Seniors should be more accepting of the conditions that come with age instead of treating them." Now remember, that doesn't include Tommy boy or Mr. Obama OR ANY representative that has ever been in office... They have free health care and pension FOR LIFE regardless of how they got into office or how long they stayed there and that includes their spouse....

Well, that is enough of my rant for now. There are other things that I want to write about and I will in the future, BUT I think this is enough to digest for the moment. Let me know if I have any information that you feel is incorrect.. I have fuzzy math syndrome sometimes.. *snicker* but I promise it is not with the intent to deceive - it has to do with 3 children pulling my hands as I type or try to use the calculator...

Love to you all - The Milk Mans Wife

8 comments:

Lucy said...

Extremely interesting. I'm sure there are ways to screw this country up more and I'm sure they will do it. How it will ever be fixed again is the question.

Heide said...

The best way to have an effective health care system is to 1. Make sure that whatever system is enacted that it would be mandatory for all federal politicians to get this, and only this medical care. 2. Not refuse VITAL treatment (not talking pink eye here) for anybody, but if someone is not a U.S. citizen then the government of the country to which they claim citizenship gets a bill for their treatment.
3. Generic drugs should not be the only option available for people (they are in our HMO unless the patient pays the difference). Sometimes the generic drugs are NOT as effective and sometimes there is not a generic equivolant so the patient gets stuck paying an exhorbitant amoung.
4. Viagra is not essential for the well-being of our nation. Medicare or Medicaid (I can't keep them straight, but which ever one the older people get, of which my grandfather is a recipient) provides monthly Viagra allotments. Heart medicine, etc. is essential. However, when aging males make up the majority of our representatives I guess their priorities might be somewhat biased.
I have lots of other opinions and venting I could take up space with here, but none of them are particularly enlightened. I'm just old, crotchety and can't keep my mouth shut.

harlow727 said...

:delurking: I've been reading for quite a while...so long I can't remember how I got here ;). LOL

All this scares me. Right now, we have private insurance through DH's work. The same insurance my parents have (DH works with my Daddy) but since my mother is disabled, she also has Medicare.

My mother has had Mulitple Sclerosis (24 years since onset of symptoms, 17 years since diagnosis) and is now paralyzed from the neck down. I worry for her future health care. Just because her body doesn't agree with her, doesn't mean her mind is gone too. I worry she won;t be considered "worthy" of the care she needs.

AND...if socialized healthcare is so wonderful, why do people from countries with SHC come to the US for medical care?!?!?!

Ye Merrie Quilter said...

Countries with socialized medicine don't, for the most part, find CURES for diseases. We pay more in this country because we are investing in finding cures. Cystic Fibrosis is a prime example--in 50 years, we have increased life expectancy from about 5 years old to over 35 years. If we move toward socializing health care, the amounts going to finding cures will dwindle.
If only we had someone in office from Wisconsin--I love America's Dairyland!

Ye Merrie Quilter said...

PS - your math looks good except the total for the year should be $1,440,000,000--but what's a million between friends? Sounds like it was a good system that didn't need to be monkeyed with.

Laughing Orca Ranch said...

Thanks for explaining this in laymen's terms. I don't think I truy understood the issues involved.
It doesn't sound like an intelligent, wise or fair plan, though.

~Lisa

threecollie said...

Just stumbled upon your blog this afternoon. I agree with most of your commenters that this bill is a nightmare. Right now my mother is dealing with terrible health issues. She is getting good care paid. Under the new bill she would be just left to die. Not what I want for sure.

Jody Blue said...

Thanks for sharing the truth that the big dogs in DC want to cram down middle America, cuz we WILL be the one picking up the tab