Tuesday, September 09, 2014

Reforming Government Controlled Health Care

When the Affordable Care Act was being considered many progressives clamored for a single payer system or, as they put it, Medicare for all. Medicaid was expanded, at least for the governors of states who agreed to accept it. While the idea sounds good, digging deeper into reimbursement rates reveals the limitations of Medicare and Medicaid. If single-payer is adopted eventually, Medicare will need to be revised substantially. It can be extremely effective in some areas and woefully insufficient in others.

Two years ago, I needed to have bladder surgery. Medicare covered almost all of it, and I'm glad that it did because the total cost was around $20,000. In situations like these, Medicare is a very effective health insurance for certain target areas, but not for others. Should you need surgery, Medicare usually covers most of the cost of the procedure. This is due to the fact that the surgeon’s lobby is very strong, but this is not the case at all for other specialists.

For patients diagnosed with sleep apnea, Medicare covers the cost of CPAP machines almost in totality, and even the very expensive one that I have. Medical supply companies have made lots of money off of CPAP machine. Some believe that CPAP machine have become something of a racket, since a record number of patients have been diagnosed with sleep apnea. My device is extremely expensive and has advanced technology. Though I appreciate how effectively it works, I wonder sometimes if gold standard CPAP devices have become much too commonplace.

Where Medicare fails most is with mental health care. Medicare only covers $65 a session for therapy, and even with a $24 co-pay, many therapists in cities do not take it. Most practices based in cities don’t accept insurance at all, meaning they charge between $200-$250 per session. Catering to wealthy clients means that these therapists make lots of money. The fsame is true with Psychiatry. Psychiatrists don’t make much from Medicare, either, and because of this many simply do not take it. This part of the system must be changed. Those who suffer from depression or bipolar disorder must see a psychiatrist regularly and must be prescribed medications they must take to be well and live a normal life.

We still do not have Universal Health Care. Medicaid is run like rationed care. It will not fill a prescription that is more than four months old, forcing patients to make a special appointment with a doctor that is unnecessary. Medicare and any other health insurance company will fill a prescription as long as there are refills remaining. Only controlled substances will not be filled if the prescription is older than six months in duration, but that’s a special case.

Medicare sends its patients an itemized statement of charges. Medicaid does not. By implication, Medcaid patients have no need for such information. Medicare patients probably complain if they aren’t given information about how their insurance was charged. I regret that Medicaid patients are not given the same essential information. Understanding the medications they are given works is crucial.

There’s an elitist perspective towards poor people, one that assumes that those without financial means don’t deserve to understand the nature of their treatment. Certain clinics for the poor and needy do an excellent job by treating their patients with dignity. But for those practitioners who aim higher and wish only to treat those like them, they often have little to no patience. Our medical system is capitalistic, not socialistic, and anyone who wants to find a psychologist with government insurance like Medicare, you have my sympathy.

I like Obamacare, but it needs an overhaul. Even at the time that it was proposed, the legislators putting the bill together knew that changes needed to be made constantly. We've made a good start, but we can't drop the ball here.

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