Sunday, November 30, 2008

The Quiet Privatizing of Medicare

I have linked the information on this topic to the title. The quiet privatization of Medicare is very carefully spelled out in the linked article. But I want to tell you how this effects a disabled person receiving Medicare parts A B and D.

For an American with a disability that eventually makes working impossible, the process of applying for State Disability Benefits is arduous, expensive and slow--very very slow. It took two years for my application to work its way through the Byzantine bureaucracy that is the disability maze. Their policy is to deny benefits on all first applications. Six months after my first application, I got my first denial. And, in the end, the only way to make it successfully through this process requires a disability attorney, but nobody tells you this ever at any point in the process. Yes, Dorothy, they do require an attorney to accept your application, and even then a judge can say, "Sorry, I'm not feeling the love today, and so, fuck you and the attorney you walked in with, waited hours with, and besides that I hate the look on your pathetic face anyway. Try again next year." It is humiliating, demeaning, and expensive. By the time you do get through the process successfully, you are bankrupt anyway. I sold my mother's antique furniture to stay afloat at the end, just to be able to eat and pay utilities.

My attorney was very skilled. And it was my lucky day that the judge seeing my case was filling in for the usual judge, who was out of town. The judge who saw my case lived in Las Vegas. I think it was his experience with crazies even worse than I that made him compassionate toward me. And once you do make it through that part of the process, you must then deal with your local Medicare and Medicaid offices. There you will face long lines and, once you get to the little window, you find the real obstructionists at the heart of any bureaucracy. They do not tell you over the phone what documentation you will need. But once you get to the little window, you will no doubt be missing one small bit of crucial documentation.

So, finally, two and a half years after my first application for Social Security Disability, I'm in the system and have received my first piddling little check. I have my Medicare Card. I have been referred to Valley Mental Health, and I have a good Psychiatrist. I've been tested and placed in a group of other women with bipolar disorder. And for several years that was as complicated as it got. But not so fast. We now have a new wrinkle in the Medicare system and guess what, you fine upstanding tax payers? Congress has quietly been doling out contracts to private insurance companies to give you less for more. And not only do they give the hapless senior or disabled person less service for more money and add another layer of bureaucracy on top of the one that has existed for a very long time, they also charge you guys a bit more because they are in the business of making money.

So, about four months ago, I got a packet in the mail about medicare coverage. This packet claimed it marked a change in the way medicare would be provided and that my account would now be covered by a plan called Evercare. I do not do well with reading the small print, but I should have called Medicare to check it out. This was the first salvo in the privatizing of Medicare. It duplicates what Medicare does, adds a new layer of bureaucracy, an enormous amount of paper--all very high quality glossy lists of this and that to confuse the elderly and disabled who often have a bit of trouble dealing with one layer of bureaucracy, let alone layer upon layer. It's smoke and mirrors. And it isn't continuous coverage. So when I go to my doctor's office with my new "medicare" card that now says Evercare, and the doctor's office makes a note of that, I start getting bills that have not been partially paid by medicare, and when I call Evercare, after going through phone mail hell, I get some jackass who tells me that on the billing date I was covered by traditional medicare. "Yessss? So you aren't medicare?" "Yes, we're your new medicare provider." "Well, I liked my old medicare provider better." "Just tell your doctor's office to bill medicare this time. Then they can bill us next time, and you'll be covered then."

What the Fuck? Is this what is meant by a ponzi scheme? I called medicare and asked why I was no longer on traditional medicare, and was told that I could indeed keep my traditional medicare, pay less and get more coverage. That it was the Bush administration's early work with a republican majority in the House and Senate to gradually, quietly privatize medicare. Holy mother of god! Just the paperwork alone must have cost millions. You should see the five pounds of booklets and formularies, and drug coverage, and exclusions, and networks, and favored hospitals, and on and on just to switch from what worked perfectly to what did not work at all.

The nice young woman at medicare spent almost an hour on the phone with me finding the best possible medicare part D drug package for me by having me give her a list of all my drugs and then checking them with all the insurance company options and found that Eatna covered all my drugs, even the diazipam and triazilam, drugs not covered by my old part D carrier. So next time you hear someone talking shit about the government bureaucracy making you have to see their doctors and how you'll get terrible care, tell them to talk to me. Bureaucracy is bureaucracy whether it's run by the government or a private, for-profit corporation with K Street lobbyists.

28 comments:

MRMacrum said...

Having done a major part of my growing up in and around DC, I ended up with many friends who naturally looked to the US Government for their employment when we left college. Most of them stuck it out and moved up the GS ladder. Their insight into the "privatizing" scheme over the years has been very illuminating.

Most people do not realize that once something is privatized, it can become an "off budget" item. That is, it is not even considered an expense when they come up with the budgets every year. An example is a photography company a good firend inherited from his father. This company does top secret work for the Pentagon at four times the cost to us citizens than it used to be done by the original founder of the comapny when he was doing it as an employee of the government.

Privatizing does not often save us money if ever. Your excellent post points out the structural reasons, layers upon layers of more bureaucrats who are not there to serve us, but serve their private employers.

I used to be more of stay out of my life type citizen. Smaller government and all that. But the absolute loss of any integrity in many of the public services that have been outsourced to the private sector have made me rethink my position. And they say old dogs cannot learn new tricks.

Gail said...

Hi Utah-
Gosh, what a horrid ordeal. I am on long term disability until age 65, or if they raise the age of retirement to age 70 then I will receive the long term disability through my work until then, I still work part time, but one never knows with my illness, M S, how it can "flare up". In any case, I wont need to go through that horror you described.

Love,
Gail
peace.....

anita said...

great, great post utah. you really are living in the 'belly of the beast' at this time.

my brother has been disabled for many years. the reasons are many and complex, but at the heart of his situation at this time is severe, chronic and debilitating pain caused by having once broken his back. again, it's more complicated than that, but bottom line is that "the beaurocracy" of which you speak so eloquently consistently denies his pain medications ... everyone in the system is afraid of being brought up on charges by the DEA. it's a real shame.

my father, who has alzheimer's, is in a nursing home strictly for people with that disease. as the disease progresses, he needs more and more medications to control his often violent moods (which is common in alzheimer's patients). but here again, there is this thing called the "donut hole" with regard to medications. they will pay up to a certain point, then you get into the 'donut hole' (a concept which completely confounds me) which can mean you (the family or the patient) are required to pay tens of thousands of dollars until you reach some other arbitrary level.

ponzi scheme, indeed.

i clearly don't know what i'm talking about here ... other than that i understand the arcane nature of the process and the arbitrariness of it all and the fact that THE PATIENT very, very often bears the brunt of it all.

Sylvia K said...

You remind me all over again of the idiocy I went through just to get Medicare and I was healthy -- just old. I didn't retire until I was 67 and because I didn't sign up for Medicare when I was first eligible they penalized me $65 a month -- not one month, but the rest of my life. And you know what I want to tell the government in general to do!

DCup said...

The idea that privatizing everything is the solution is nonsense. I'm glad that you are in a position to be your own advocate. Imagine the number of people who just shrug their shoulders and don't ask questions.

Dusty said...

I have to say the HMO that covers me via Medicare is quite good and locally owed and operated.

But then...I have only been in the 'medicare system' since Oct 1st..

Utah Savage said...

Dusty, why do you need a private insurer between you and medicare? It just costs taxpayers more and gives big phrama and insurance companies the toe-hold they need to eventually take over medicare. I understand that that medicare part D is structured to include the insurance and parmas companies, but part A and B were not. Medicare does a great job with out that corporate privatized handout that costs all of us more and gives republicans the excuse the have always wanted to do away with medicare and medicaid. And you can go to whatever doctor or hospital you want with medicare.

Utah Savage said...

Please read MRMacrum's comment above. He talks about moving things in the budget, off-budget and then you can kiss your benefits goodbye.

Dusty said...

I have very little output cash wise with the HMO. No visit copay, I love my Dr and my husband has used him forever.

Medicare on it's own has a lot of cost's upfront for me in the form of deductibles. The HMO does not. They take my Part B charge and use it as a monthly payment for being in their HMO.

Yes, I could see any doctor I want, but I am seeing the doctor I want now under the HMO. Plus, Medicare straight will only pay 80% of what they deem normal and customary..the rest I am responsible for. My HMO has no charge for my primary doctor office visit.whereas Medicare does.

an average patriot said...

The right wants to privatize everything! Listening to Romney was scary.just imagine if Bush succeeded in privatizing social security. With the collapse he would have finished off average Americans in one fell swoop. Remember his desire to reduce unfunded liabilities?

Dusty said...

Patriot:
I have no problem with govt-run healthcare. But I get a better deal from the Medicare Advantage HMO, so why wouldn't I take it?

I want to support a govt-run healthcare but right now, its not as good as the HMO I use. I do not use a huge national chain, its local and I can go into the office and talk to anyone within the organization I want. I have the right to bitch if I don't like their ruling on something I need.

I am a rookie in this endeavor, so maybe I don't know all the ins and outs..but I know how much money it takes and I spend a lot less for the HMO Medicare Advantage than I would for straight Medicare coverage.

D.K. Raed said...

I hate the sneakiness of it above all else! I'm so glad you got it sorted out. Privitizing so many things has not proved more cost efficient, just more profitable for the govt contractors.

It's not just medicare that needs an overhaul, it's the whole healthcare vs health insurance system. See Germany or Switzerland for ideas, Prez Obama.

I personally won't have to face this for a few more years, so I hope it's an easier process then. I can always hope (for a Vegas judge if nothing else!).

Ghost Dansing said...

you really nailed it..... the Republicans basically feel that government is the only entity that can deliver bureaucracy. it's all okee dokee if it is some insurance conglomeration establishing bureaucracy intended to deny service as a profit-making strategy...... what a bunch of crap...

Utah Savage said...

Thanks Ghost, D.K., I've been dealing with another major financial problem today--property tax. Which I will no doubt be writing about tomorrow. What a fucking nightmare. Housing values have plummeted yet property taxes are up. They way they pulled this off was to devalue the house but up the value of the land the house it on. Sweet huh?

Beach Bum said...

Who needs expensive socialized health care? Mr. Bush has assured us that all we have to do is go to the emergency room.

D.K. Raed said...

UT I was gonna remind you about paying your PPT, but I didn't want to be a nag! I was tempted to protest mine, even got the forms to do it (deadline to file those was in Sept). In the end, it wasn't worth it because they are basing the PPT due 12/1/08 on property value as of 12/31/07. Here, prices hadn't dropped so much by the end of LAST year, and they were requiring too much proof of what similar homes sold for as of LAST year. What if your home had no comparable on the market then? Anyway, I will wait til next year's notice to see if they reflect the much lower market values of 12/31/08. If not, they can expect a flood of appeals.

And oh BTW, the home builders around here have told us that home construction prices have stayed apprx the same (per sq ft) over the last 2 yrs, but that LAND acquisition prices have DROPPED. Of course in your part of UT it may be the opposite.

Utah Savage said...

Could they have picked a worse time of year to make us pay property tax? Jesus. Heartless bastards.

D.K. Raed said...

yeah, they are grinches. In Calif it was half due April 10 & the other half due Dec 10. What I really hate about Utah PPT is the rape rate they charge for non-primary homes and land. What difference is it to them if you live in the home 182-days that year or not? And why on earth is Utah taxing plain old land at the highest rate? Land that is unbuilt on is causing the least stress on community services. You'd think it would qualify for a lower tax rate.

Utah Savage said...

Here's another thing. I pay for garbage pickup and sewers and water and all the other sundry items that make up my City/County Utilities. But then I get charged again on my property taxes. WTF?

Kulkuri said...

Those who think government is the problem have no quams about plundering the government coffers and handing it to their friends. i.e., Privatization.
It always works out to less services that cost more!!

Randal Graves said...

We need to privatize comments. I'm sick of all you bastards commenting at the expense of the American taxpayer.

Nan said...

I think Dusty's example is an exception, not the rule. The horror stories I've heard about people moving from traditional Medicare to an HMO far outnumber the success stories.

As for privatization in general, one of the things I've noticed is the lack of accountability. When I worked for the National Park Service we'd pay contractors significant sums to do work that used to be done in-house, and then when we got the deliverables (historic structures reports, cultural landscape reports, ethnographies, whatever) half the time they'd be crap. The contractors would have ignored all the review comments, failed to fix any of the problems noticed in early drafts, and basically dumped a stinking pile of dung on us with no consequences. We couldn't even use bad past performance as an excuse not to hand them a new contract in the future.

Dusty said...

My HMO, GemCare, is a small local company that only serves Kern County.

That might explain why it is better than 99% of the huge corporations that run the rest of the health insurance industry.

http://www.gemcarehealthplan.com/en/medicareplus.asp

Dusty said...

oops..I meant to put this link in:

http://www.gemcarehealthplan.com/en/medicareplusbenefits.asp

Utah Savage said...

Dust, I hope you realize I'm not picking on you for using a private HMO to manage your medicare situation. But if the rest of us buy into the Big Insurance Companies slice of Medicare there soon will be no Medicare at all.

Dusty said...

No, I am just lucky that a small local company is good at what they do Peg.

I am in the minority, I admit that. But I also checked out all the plans available to me at the Medicare website, and I think smaller was better than anything else that was offered, including the govt's own Medicare.

My point I guess is, not all companies are bloated and give us less. There is a way to make private companies responsive to the needs of their customers and they still make a profit.

D.K. Raed said...

I just now got a robo-call poll for Medicare Advantage that might interest you, UT. Like all robo-calls, this one was worded in such a way that you want to say YES. If I hadn't read your link in this post, I probably would've said YES.

What it said was Congress is considering removing Medicare Advantage which would deprive many seniors from savings on their medical expenses. And that I could join "500,000" voices telling congress to save Medicare Advantage by pressing "1" now.

(now, who do you think sponsored this robo-call, and don't you love they way they worded all that?)

Utah Savage said...

Never ever answer a robo call. The moment I recognize that the call is a recording I hang up.