I'd like to share with you a tale of horror concerning our very badly broken health care system. First the facts.
As my friends are aware, I had a little dust-up with throat cancer back in 2006. As I have told many people since, cancer is easy to beat, it's cancer treatment that gets you. The radiation therapy that killed the cancer also did a number on my esophagus. I can no longer swallow and have tube fed for three years. That, in concert with some other permanent side effects means that the Social Security Administration deems me to be disabled. That status also means that I became eligible for Medicare before my 65th birthday. The plot thickens.
In going over the mountain of information and literature available about Medicare that one can find on-line I came across an interesting reference. It seems that Medicare will help pay for what's called Enderal Nutrition. What is enderal nutrition? Why it's the formula which yours truly pours through a tube into his stomach four times a day. And that horrible government run health plan called Medicare will help pay for it. This was starting to get interesting.
Now, anyone who knows me well can tell you that I like to be parsimonious. Waste not want not and all that. Back in the day when I was a roofing contractor I took great pride in never ordering more roofing than was needed and then using up every possible piece and scrap to finish the job. So saving some bucks by letting Medicare pay for what I've been paying for for the last three years was pretty appealing. Not that I was spending all that much. I very kind nurse in the hospital where I received the feeding tube told us that you could order the formula they use in the hospital or just use the WalMart version of a nutritional shake. Well that's all it took. We stopped at Wally World on the way home from the procedure for the first cans and that has been my exclusive source for nutrition since.
Now I'm currently paying $6.87 per 6 pack or $27.48 for a case of 24 cans. Doing all the math means that I need $240 worth of "food" a month. $8.00 a day is not bad, but if Medicare picks up 80% that's even better. So off I went down the rabbit hole.
After some more research I discovered that WalMart is not what Medicare accepts as a provider of enteral nutrition. That would have been far too easy. So back to Google I go until I land on a manufacturer's web site. Not only do they have what I need, but they will deliver right to my door. I call. I wait on hold. I play Solitaire and wait some more. Finely, a very nice young lady explains that the brand name product I need will cost $37 per case. I thought, fine, Medicare's going to pay 80% anyway. "No problem," I said, "So how does this get billed to Medicare?" Oops. Seems that they don't do Medicare sales. I would need to find a provider locally. Just a minor setback. Nothing to worry about.
A quick trip to the yellow pages and I found a local medical products company. The very nice lady there told me that once I get an order from my doctor they can get the product and deliver it to my door. I asked how much my share would be, put she couldn't say until it actually came in. Okay, that sounded good, and since I already had an appointment with my doctor, things were moving right along. The doctor visit and a few phone calls and faxes later and my order for six cases of nutritional shake would be on my front porch.
The six cases came today. In the course of signing nine different documents acknowledging receipt of the cases among other things, I came upon the document that said that if my insurance declined or refused to pay that I would be responsible for payment at the rate of $11.88 per can.
Let's see now, $11.88 per can equals $285.12 per case or $1,710.72 per month. And how much would my 20% co-payment be? $342.14. So if I order from the approved provider I can pay $100 more per month for the convenience of having this stuff delivered and Medicare can pay $1,369 for a product that I buy now for $240! This is messed up.
Needless to say, I will not be ordering my nutritional needs from that provider nor will Medicare be helping me pay. My friends on the right (you know who you are) are probably crowing loudly how this proves just how broken the "Government Run Health Care" that we have is and why we should abandon "Obamacare" just as fast as we can. I see a different lesson here.
One of the administration's arguments for the health care plan now before Congress is that it will save $500 billion from Medicare over ten years. The GOP points to this and says, "See, they want to cut Medicare." But clearly, there are huge sums that can be saved if someone just works at it a little. The government will pay over seven times the retail cost of this one product the way the system works now. Is it the GOP's contention then that the greatest nation on the face of the earth, the country that put a man on the Moon, invented the light bulb and the Twinky, can't figure out how to not spend $1,700 for $240 worth of product? I'm just curious.
So that is my tale of horror. Hours of research, hours of phone calls and many games of Solitaire later and I'm right back where I started. Oh well, I got a blog post out of it. Is it time for dinner yet?