[tri-med] Re: Public Health Care Alert in UK

>Ahhhh but that was the doctor and in part the hospital not medicare.

True, but here's the tie in...

I've spent too many years as both a nurse and a healthcare consumer
(patient, family member & friend) in this state, not to be scared
sh*tless of the potential under this bill being considered, for my
family to ultimately end up on public based managed care.  And don't
for a minute think that a public run program won't be managed care.
Federal gov't mandates programs, but states run and usually end up
funding them.  And our state is already handing out IOU's for the
programs they're running now.  But frankly, private HMO/managed care
is no better really, which is why I won't have anyone I love on it
anymore either.

When I 1st entered the nursing profession, I was working in a corporate
owned convalescent hospital that was predominantly medicaid covered
consumers.  Facility gets X $'s per day per patient cared for.  Facility
administrator, who was actually a retired military brass/not medical, and
hired for his leadership ability, received a bonus if he could keep the
expenses down and the profits up.  So every time the budget would start
getting to the point of endangering his bonus, our non reusable supplies
would dry up.  Leaking catheter bag or tubing?  Stick a bedpan under it
until the next month's income arrived.  Unless of course they were up
running around in a wheelchair or ambulatory, and then they'd be dripping
on the carpet.

Now, before you start thinking that the answer then is to do away with
the private (for profit) medical facilities, and go to government owned/run
managed care ones, think back to the recent VA hospital scandal.  That would
be like having the fox guard the hen house!

And let me remind you of my observations of family/friends private managed
care facilities experiences.  Both of these are with a MAJOR managed care
insurer, who has their own clinics & hospitals.

The friend who's cat I was picking up from the vet (who freaked when she
heard
Philina's heart murmur), saw the same doctor all the way through her
pregnancy
in the HMO (managed care) clinic.  But the clinic doctors only do the
prenatal
care.  When it comes time to deliver, they send you over to their hospital
and
who ever is on duty delivers, because no one is on call in their managed
care.
So when she was 2 weeks past due, he tells her to go check herself in and
tell
them that she's going to need a cesarean, because the baby is too big. But
do
you think that HE bothered to tell them?  Heck no, he was done and off the
case.
So I drove her over to their hospital and helped check her in 3 days before
Halloween.  She told them what the prenatal clinic doctor had said about a
c-
section, and they just rolled their eyes and said, 'We'll see!'.  The doctor
on
duty when she arrived said, 'Let's get this baby deliver!', and put her on a
Pitocin drip.  But several hours later he went off duty for his days off,
and the
next shift doctor didn't like the way the baby was responding to the drip,
so he
dc'd it.  To make a long, long story slightly shorter, every shift for the
next
couple of days either started the drip or dc'd it, until that 1st doctor
wandered
back in on Halloween, and asked, 'Why are you still in the delivery unit?'.
So he
starts the Pitocin again, and does a radical episiotomy and forceps, only to
end
up with the way over sized baby hopelessly wedged in her birth canal.  So
now she
gets the c-section that the clinic doctor told her she needed 3 days
earlier.  She
gets to deal with stitches both up and down, and one whole side of her son's
head
is bruised from being stuck.  But it's 2 years before the seizures are dx'd,
and
even longer for the hearing loss and severe communication disorder, so she
couldn't prove that the birth experience was to blame, and HMO got off scott
free.

Then there's my father-in-law, who at 85 was out walking a golf course at
least
once/week, and did extensive traveling in his motor home.  That is until he
missed
a step getting down and wrenched a knee.  Same HMO as above declared that he
was
too old to waste the expense of an implant on.  But they let him spend a
while in
their hospital to recoup.  When he maxed out on allowed hospital time they
sent him
home for his 90 yr old wife to care for, by herself.  He couldn't walk, or
even safely
help transfer himself to a wheelchair/toilet. But too bad, because his
managed care
allowed days were up.  1st night at home he took a major fall going to the
bathroom
and ended right back in the hospital, where he caught a nasty virus and had
an
isolation order placed on his chart.  About the same time he recovered from
the virus
his allowed hospital stay days ran out again, but this time they agreed to
send him
to a rehab facility to get him ready to go home.  Only the doctor on duty
when he was
transferred failed to remove the isolation order, and his days at the rehab
were almost
over by the time we became aware that they hadn't ever started rehab,
because he wasn't
suppose to leave his room.  Needless to say, he wasn't in any shape to go
home when his
allowed days ran out for rehab, and his wife obviously couldn't care for him
either, so
they made plans to admit him to long term convalescent care.  But as someone
else on
here recently wrote about a similar case, that was the last thing that he
wanted, and he
died of a heart attack the night before he would have been transferred.

I could get this same insurance through my union for a lot less then we pay
for the PPO
through Doug, but I wouldn't waste my money on it!

>Thanks to medicare we have the option to ditch that doctor which we have
and to
>choose another doctor which we have.

Not necessarily much help though when the managed care dictates the budget
(and frequently
limits which doctor/facility you can use) regardless of which doctor you're
seeing.


>Yes I am limited in my choice as to which hearing aid he can get, because
the
>system doesn't recognise the significance of monaural loss. But thats the
same
>in the US. Hearing aids are NOT covered by medicare. That is a different
scheme.

In CA you can't get ANY hearing aid now from medicaid, and there is no other
scheme!
Audiology services aren't covered at all, even for the aids already gotten
through
them, as of the new fiscal year (July 1st).

>Attitudes ARE changing - thanks to the horror stories and advocacy of
children like
>Alex and Tess and others.

And what I'm kind of afraid of too is that under strictly gov't controlled
managed
care, we will actually lose ground on those attitudes in this country.  I
know the
day is coming when Miss P will need another heart valve, and I'd really
still like
to have the private insurance option when she does.

>For example Philina would not have gotten an electric wheelchair through
the
>government funded programs here, she would have gotten a manual chair and
if it
>didnt need to be customised then it may not have been brand new...If there
came
>a time when she no longer needed it then it is returned to the hospital to
be
>reused for someone else.

And that was the case with the one they gave Miss P.  Some one had donated a
used
power chair to the cardiology department.  And bottom line is they felt so
bad
that she had walked into the facility and put herself up on the bed to be
taken down
to the surgery that was suppose to improve the quality of her life, and the
more they
did to her the worse it got.  So they gave us the chair for her, probably as
a peace
offering.  And when it became apparent that she wasn't going to need it, we
returned
it to them for the next 'oops'.

>Doesn't your private insurance have caps?

Certainly some have!  But she has been on so many different PPO's in
addition to the
2 HMO's & some 80/20 ones, that caps have never been an issue.  Even with
BC/BS she's
been on 3 different PPO's (of California, state high risk, and of Minnesota
[while
living in CA, which is legal if the company dad works for is based out of
that state.])
Plus, I suspect that when she's gone back on previous plans the $ meter has
been reset
to 0 and all those previous bills paid are lost somewhere in an old file.

Dad hasn't really worked that many different jobs since she's been born, but
the nature
of his industry (buy outs/mergers), and company efforts to keep health
insurance costs
down, have had us changing plans every few years.  Which is not a problem
with health
insurance portability.  Since she was covered under his previous plan, she
is covered
under the new one with no preexisting condition clause.  This is why we
refuse to let it
lapse!  And it's not that much more to cover her too as it is to cover me.
But under this
proposed public managed care plan, page 16, next time they want to lower
costs, she will
lose her access to private PPO.  And once it's gone, the odds are it's not
coming back.


>>Under strictly a public health plan though, I suspect that today she would
either be
>>dead, or sitting in that wheelchair in diapers, with a trach, and still
being tube fed.

>Why? Here the same doctors who would treat Alex privately are the same ones
>who see him publicly and often in the same hospital.

Here to, but with budget cuts for managed care, both program & facility, as
well as private
or medicaid, I don't think she (with a rare trisomy) would have gotten the
'gold standard
care' she did then on her PPO.  Or will the next time she needs it. And
let's not forget that
her PPO didn't limit her to how many days she could stay in any of the wards
either.  She
got to stay until SHE was ready to step down or out.  And though some of the
care was
certainly misguided, at least they kept getting paid, and trying until they
got it right.

Fawna, Research coordinator Tracking Rare Incident Syndromes Project
mom to Thom & Rhonda, Lara & Brian, & Philina 26 yrs(PT6p & Moya Moya)
Escondido, CA USA http://home.mindspring.com/~fawna33/




                  Building ___ooOOoo__ Rainbows
                       www.trisomyonline.org
                  Families Helping Families On-line

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