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As a former nurse, ex-spouse of physician, current lawyer and patient, I'm offering a few, unrelated, random thoughts.
Physician's salary: Ex is a primary care physician. I don't know his current salary, but the most he earned during our 30 years of marriage was about $145,000/yr.
Malpractice stuff: I was never a malpractice attorney but I believe eliminating malpractice claims won't accomplish very much except in the field of ob-gyn.
As a patient, I've noticed a fairly recent reluctance on the part of some medical providers to order expensive tests and, in general, I agree with that position. I just read in our local paper that one of the leading hospitals in my community has received a grant to study the effects of "cutting diagnostic testing":
In a week or so, I'll be consulting with a neurologist regarding the results of a thorough neuro-psychological examination. The neurologist should order a brain mri and/or brain ct scan and/or PET scan. It will be interesting to see if he readily suggests one (or more) of these tests or whether I'll need to raise the issue. My limited experience at Johns Hopkins has been positive thus far - clear communication and physician-patient collaboration.
Oh, and regardless of who has provided my medical care, I've never spent less than 15 or 20 minutes consulting with a physician. Never.
As a former nurse, ex-spouse of physician, current lawyer and patient, I'm offering a few, unrelated, random thoughts.
Physician's salary: Ex is a primary care physician. I don't know his current salary, but the most he earned during our 30 years of marriage was about $145,000/yr.
Malpractice stuff: I was never a malpractice attorney but I believe eliminating malpractice claims won't accomplish very much except in the field of ob-gyn.
As a patient, I've noticed a fairly recent reluctance on the part of some medical providers to order expensive tests and, in general, I agree with that position. I just read in our local paper that one of the leading hospitals in my community has received a grant to study the effects of "cutting diagnostic testing":
In a week or so, I'll be consulting with a neurologist regarding the results of a thorough neuro-psychological examination. The neurologist should order a brain mri and/or brain ct scan and/or PET scan. It will be interesting to see if he readily suggests one (or more) of these tests or whether I'll need to raise the issue. My limited experience at Johns Hopkins has been positive thus far - clear communication and physician-patient collaboration.
Oh, and regardless of who has provided my medical care, I've never spent less than 15 or 20 minutes consulting with a physician. Never.
Thank you for sharing your "unrelated random thoughts". You obviously have worked hard to achieve success as a Nurse, then as an Attorney. I sincerely hope this is matched by success as a patient.
THIS is what is devastating for us--much more than medicare/health insurance problems. We did everything right--lived frugally, saved enough and managed our own retirement portfolio, and then we put everything into safety for retirement---CDs and Treasuries that were paying average yields of 5%---which gave us good income above inflation, but now they are coming due (maturing) and the income hit we will take since yields are almost 0 and will stay that way for at least another 2 years (thanks to Bernanke) is devastating. We are experimenting with GNMAEs which are the only semi-safe thing we can find that's still yielding around 3%. But they have more risk, and have to be watched constantly. Grrrr
You can still buy 10 year brokerage CDs at 3%. High quality longer term munis can yield more. Robyn
Well, this has certainly been interesting to follow. I have a question for each of you, which I'll answer after posing the question.
If you accept that there will be changes to "Medicare", (includes Medicare Advantage, Part D, Medigap policies, and so forth), of some sort, of which none of us can accurately predict, nor control. Within your control, what are you doing that will help you to prepare and eventually deal with the changes?
For me.
Have an advanced directive/living will in place.
Exercise regularly (gardening in a big way and some long strolls, short hikes).
Quit smoking 8 years ago. Haven't had a drink of alcohol for 20 years or so.
Eat lots of veggies, and fruits, light on red meats, heavy on fish.
Keep my weight down.
Eat out, maybe two times a month.
Live frugally (have been learning how to do that more and more) and plan to cut back more at retirement in 2~ years. I'd be a fool to think that costs to live - the basics, food, shelter and healthcare - will not increase at an accelerating pace. Demographics bake that in.
Am into acceptance and personal responsibility as a way to live. I know I am not in control, so I strive to turn everything over. Limits stress greatly.
Adjust as I need to. Sometimes voluntarily, sometimes kicking and screaming. But adjust I will.
I am not particularly a fatalist, nor interested in a specific political parties view of the "correct' solution. As the kids say, it is what it is. Thanks again for everyones' viewpoint.
And when you wind up with your terminal illness - perhaps at age 90 instead of age 80 - then what? I believe about 25% of all Medicare payments are made in the last 6 months of life.
Mark is on point with this - spending big end of life bucks with very little bang for the buck. Robyn
People would not be just starting to purchase their insurance at retirement age, they would have starting purchasing their insurance at a young working age just like we purchase LTC ins, home ins, life ins. The federally funded programs for the really economically poor and disabled indiviudals would be there, especially for those full retirement age (70, as we seem to be aiming for) who fall below the poverty level. Everyone else purchases their own, as those who retire early before Medicare age have to. People just have to be sure that they plan, with their pension and other retirement income, to include the premiums in their monthly expenses. Look, how long can Medicare continue to pay 80% of my or your medical expenses over the course of 20 or 30 years, on the measly $115/month we will pay into it? With the enormous wave of boomers arriving at old age, the Medicare program is clearly going to go bankrupt. There are many people who have expressed disdain for the program, and these are the ones who are no doubt able to pay for private insurance. Why not let them? And by doing so take those millions off the Medicare program? IMO now, "Medicaid" should become "Medicare"....for the genuinely poor, disabled, and very low income seniors, whatever age. They will not be "left behind."
I don't think private health insurance is feasible economically for most older people. I am 64. And in my state high risk health plan. Where I pay (by statute) 125% of the average individual health insurance premium. It is now about $550/month - with a $10k deductible and a 20% co-pay up to a max of an additional $3k a year. Note that I live in a low cost area of Florida. The premium for my plan is about 40% higher in high cost areas of Florida (like south Florida). In addition - I pay about $600/year for a group excess health insurance plan (through the Florida Bar) which covers 100% of my expenses once I and my insurance company pay more than $25/k over a rolling 3 year period.
OTOH - I used to think I'd save a lot once I went on Medicare. As the years have gone by - the amount of money I think I will save has gone down. Especially when it comes to drugs. I say that in part because I look at my husband. He is now changing his cholesterol drug from generic Zocor to Lipitor (for various medical reasons). That one drug alone will cost him $42/month under his part D drug policy.
I'm not sure there are any great answers to this problem. But I know there are some. For example - do away with MRIs when - no matter what the result of the MRI - the treatment wouldn't be any different. My 93 year old father had at least 4 MRIs for a damaged rotator cuff when he was 75+ - when he wasn't a candidate for surgery no matter what the MRI showed. OTOH - sometimes MRIs are useful. My husband had 5 earlier this year for his MS. And one showed he had no ACL left due to leg weakness that tore up his ACL (a somewhat unexpected finding). He wound up with a new leg brace - and a cane - and he walks better now. Expensive tests resulting in some inexpensive fixes.
One thing I would most certainly do is kick up the programs to prevent Medicare fraud. South Florida is the Medicare fraud capital of the US - and Medicare fraud is estimated to cost about 10-20% of total Medicare expenditures. A south Florida judge recently sentenced someone to a 40 year or so sentence for a $100 million+ Medicare fraud. If we could get rid of this fraud - even half of it - it would be a huge money saver. Robyn
Maybe the physicians who charge outrageous fees should think about how that affects the whole system. My husband had 6 docs/day come in and say hello and listen to his lungs. Multiply $275 times 6 to get just that one cost/day. And, they come in for 5 minutes. There's no collaboration--each ego needs its' "share." Collaborative medicine is one answer. There is huge duplication of services that goes on and waste. If that where really weeded out and cut, it would help. Also, over-testing. For every symptom, docs are obligated to over- test and practice defensive medicine and many hypochrondiacs who abuse the system.
What does your husband have? Is he in a hospital? And what 6 doctors are seeing him every day? I am not a big fan of "medicine by general anecdote" - and like to know the specifics. Robyn
I don't think anyone has actually visited the subject of what the doctors charge versus what the insurance actually pays. We frequently get blood work done - earlier this year my blood work for a single visit amounted to $2100. Our insurance paid something like $200 and we paid around $12 - that was our total cost. I am not on Medicare but my husband is - we both have Blue Cross insurance.
I guess if someone without insurance has that some blood work done, they would have to pay the full $2100. But the lab was willing to settle for $212 (I understand that there is an agreement between some doctors/medical groups and insurance companies as to a payment scale). We notice a substantial disparity between what is charged versus was is actually paid on all medical bills and statements that we receive.
One thing I would most certainly do is kick up the programs to prevent Medicare fraud. South Florida is the Medicare fraud capital of the US - and Medicare fraud is estimated to cost about 10-20% of total Medicare expenditures. A south Florida judge recently sentenced someone to a 40 year or so sentence for a $100 million+ Medicare fraud. If we could get rid of this fraud - even half of it - it would be a huge money saver. Robyn
I have said this before but it bears repeating. In the 30 or so years as a health claims adjuster I saw a great deal of fraud by the medical industry towards the insurance companies. So Medicare fraud does not surprise me in the least.
I myself uncovered fraudulent billings both while on the job and blew the whistle loudly. In the past, before computers it was incumbent upon the claims examiner to go over bills with a fine tooth comb. We were taught how to do this. Hospitals were the worst offenders.
In the past, all bills had to be itemized or the insurance companies would not accept them. The patient got an itemized bill too. Now everyone gets summaries with no explanation of the diagnosis or service codes.
Nowadays we have electronic billing, bundling and PPO billing all very convenient for the providers of service but impossible for the claims adjuster to catch fraud because the services are not itemized. We have computers to thank for this.
Not that I would go back to processing claims manually. No one would want to do that. The patient can ask for itemized billings and go over them. Patients can tell whether or not services were rendered. I have been charged for outpatient lab services I never received along with services that were rendered. I made sure the incorrect ones were taken off the bill. It happens all the time.
We can all help cut down on a small part of these "mistakes" or downright fraud. But we as consumers have to start thinking of our medical services and charges as we would any other consumer item. How many of us come home from the grocery store and check our receipts to make sure we were charged correctly? If our electric bill goes too high, we are on the phone with the utility company.
So why are we so compliant and trusting when it comes to our medical bills? As consumers, it is up to us to make certain that the charges we receive from our medical providers are correct. And if something does not look right, we need to ask why.
I think the individual can help reduce both Medicare and other health insurance fraud from the service/billing standpoint. But unfortunately, it will take some kind of government intervention to go after the larger perpetrators of fraud like the schemes that are showing up in Florida.
Of course their are crooks in nayhting that money is involved in;not just medical. But the new systems of code and treatment wil solve most of that. In afct I thnik we are in for a severe reduction in treatemnts and testing based on approved treatejmnts. heck there is alot of fraud in claims denied under contracts een. We are dealing with humans.
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But adjust I will.
