Monday, April 14, 2008

Is Soylent Green In Our Future?

Oh, the humanity! Or lack thereof. Baby Boomers have been approaching this point for over 65 years and the system isn't prepared for them. Why am I not surprised?

As more of us become seniors, there will be fewer medical services available and fewer providers who are trained and willing to treat patients for a hugely discounted reimbursement rate. Meanwhile, individual costs for services continue to increase and heaven forbid that you need a prescription. Nothing like being sick, having insurance and your portion of the bill is more than you make in a month. What's the point? To prune the system of those who can no long contribute?
Private insurers began offering Tier 4 plans in response to employers who were looking for ways to keep costs down, said Karen Ignagni, president of America’s Health Insurance Plans, which represents most of the nation’s health insurers. When people who need Tier 4 drugs pay more for them, other subscribers in the plan pay less for their coverage.

But the new system sticks seriously ill people with huge bills, said James Robinson, a health economist at the University of California, Berkeley. “It is very unfortunate social policy,” Dr. Robinson said. “The more the sick person pays, the less the healthy person pays.”

Traditionally, the idea of insurance was to spread the costs of paying for the sick.

“This is an erosion of the traditional concept of insurance,” Mr. Mendelson said. “Those beneficiaries who bear the burden of illness are also bearing the burden of cost.”


Julie Bass, who lives near Orlando, Fla., has metastatic breast cancer, lives on Social Security disability payments, and because she is disabled, is covered by insurance through a Medicare H.M.O. Ms. Bass, 52, said she had no alternatives to her H.M.O. She said she could not afford a regular Medicare plan, which has co-payments of 20 percent for such things as emergency care, outpatient surgery and scans. That left her with a choice of two Medicare H.M.O’s that operate in her region. But of the two H.M.O’s, her doctors accept only Wellcare.

Now, she said, one drug her doctor may prescribe to control her cancer is Tykerb. But her insurer, Wellcare, classifies it as Tier 4, and she knows she cannot afford it.

Wellcare declined to say what Tykerb might cost, but its list price according to a standard source, Red Book, is $3,480 for 150 tablets, which may last a patient 21 days. Wellcare requires patients to pay a third of the cost of its Tier 4 drugs.
So why have insurance if it doesn't help you when you are down and out or on the way out? If everybody quit paying their premiums, the insurance companies would go out of business eventually and the system would have to change. While I understand about the costs of research and development, pharmaceutical companies should have to lower their prices so the average person could afford their prescriptions or is it only the rich that deserve adequate health care in this country? Once you reach a certain dollar amount, you are determined to be a drain and even though you may have contributed to the system all your life, it is more cost effective to eliminate you. Even Superman was affected by these policies. If Christopher Reeve had lived much longer, he would have used up his lifetime benefit and been left without proper coverage. Since he had a preexisting condition he could have kissed the idea of switching insurance companies goodbye.

Providing good medical care has become a business whose only concern is the bottom line, not the welfare of the patient. Hippocrates would be so proud.


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