Who Is To Blame?

Discussion in 'Fibromyalgia Main Forum' started by Mikie, Jan 7, 2006.

  1. Mikie

    Mikie Moderator

    Whenever I read posts about docs taking advantage of sick people, I feel I have to expand on that. I posted this on a thread which is getting heated and I don't want to lose this if the thread is removed.

    Yes, there have always been greedy docs. One of the best, and most well known, specialists in FMS makes money teaching other docs how to make money off of FMS patients without involving insurance companies. He holds seminars and charges other docs to do what he does. Still, he is a good FMS doc and has helped people.

    Because of greedy docs, many who performed unnecessary procedures, managed care came into existence. Some managed care plans are good and some are not. Insurance companies are very profitable because they keep costs down. They also deny care in some cases. Insurance companies are some of the biggest contributors to political fundraisers. Insurance company profit motive and doctor greed are two ingredients which have added to the present day crisis.

    Then, there is the govt. which does little and when it does, something horrible, like the Medicare Rx Plan, is the result. Medicare audits almost none of the claims it receives so the greedy, and crooked, docs can engage in Medicare fraud with very little fear of getting caught. I remember when the Clintons tried to get congress talking about healthcare and they were pilloried. How anxious will any president be to bring up this subject again?

    In addition to turning its back on healthcare, the govt. continues to allow pharmaceuticals to price gouge Americans and cut rates overseas on their drugs. Again, Clinton has worked to get low cost AIDS drugs for Africa but admits the pharmaceuticals won't cut costs in the U.S. on them. Medicaid (the taxpayers) has been covering the cost of the AIDS drugs.

    The govt. also allows industry to pollute our environment. Govt. oversight of industrial pollution has devreased over the last few years. Toxins cause illness. Big business, through lobbiests, pays off those in office to throw favors their way. The current Abramoff (sp?) scandal is likely the tip of the iceberg.

    There is plenty of blame to go around for the patients. How many Americans are making an effort to stay fit and keep their weight down? How many indulge in unhealthy habits? How many let their kids ski, ride bikes, and rollerblade without the proper protective helmets and padding (for rollerblading)? How many try to learn about proper nutrition and ways to avoid illness? How many see their health care providers for preventive care and follow the recommendations?

    I once stood in line at the grocery store behind a man who was checking out. He was past being morbidly obese. His face was bright red and he was gasping for breath. He opened a package of cookies and was eating them while he checked out. When the clerk asked him if that was all, he asked her for a carton of cigarettes. Now, I don't know this man and I have no idea what he has gone through or why he is behaving so destructively. I wasn't judging him but rather observing all this. Granted, this guy was an extreme example, but I'll bet most of us could stand to improve areas of our own health which are under our control.

    Obesity and stress-related illnesses are on the rise in the U.S. So is poverty. These things combined cost us all money in taxes to pay Medicaid and in higher insurance premiums. Why do hospitals charge private pay individuals more than they are willing to accept from insurance companies? Because they have to make up for what they cannot collect from the uninsured who cannot pay. Most of the private pay individuals fall into that category.

    Finally, technology is growing in leaps and bounds. Problem is that it is expensive. The news media always hype the new treatments and tests, but do they really save lives? How much of our resources are we willing to commit to expensive tests which may show early disease in one in ten thousand people?

    When we are upset, it is only natural to look for someone or something to blame. If we really want to figure out what is going on, though, we need to take a broader look. As I said above, there is plenty of blame to go around.

    Love, Mikie
  2. CanBrit

    CanBrit Member

    In Canada, we are fast approaching our own health care crisis. Everyone fighting to keep a universal health care that just can't be sustained any more. The medical profession looks with distain on the government and the government is too busy trying to make themselves look good (not working though!)

    We have animals here that can get an MRI in one day. For the rest of the human population it's months. Knee replacements waiting list are at 2+ years. Even for cancer surgery, there's a waiting list.

    Having said all that, I can totally understand why some doctors try to screw over the government. There's alot of frustration here and it's only going to get worse.

    We all have a responsibility to manage our own health to the best of our ability. My father is a retired family physician and was one of the best. My current family physician thinks that they'll find a "real cause" for FM. At least he gives me medication to control my pain. My rheumatologist who has FM as one of his specialties, does not believe in giving pain medication! Go figure.

    I'll will continue to try to learn everything I can about my conditions and how to help myself.



    [This Message was Edited on 01/08/2006]
  3. NyroFan

    NyroFan New Member

    Very thought provoking. Thank you for posting.
  4. QuayMan

    QuayMan Member

    Another thing that I've noticed is that when people complain about there not being enough money for research into ME/CFS and FMS, they always blame governments and the like. Yet, the reality is that only a very small number of patients (and/or their families and friends) donate and/or fundraise for research into these conditions which they have themselves.

    Especially outside the U.S., the amount available for research is relatively small when one considers that it has to be spread around hundreds of major conditions as well as thousands of others and basic research that isn't specific to any one illness but could end up benefiting lots of illnesses (an obvious example was the Human Genome Project).
  5. kbak

    kbak Member

    Hi Mikie,
    Can't really argue with anything you've said.

  6. vickiw

    vickiw Member

    let's add the legal system - both lawyers and people who abuse the system. NJ has more lawyers than any other state (at least that's what I heard), ergo, more lawsuits. A friend of mine, formerly an obstetrician, moved out of the state because the malpractice insurance rates for that speciality in particular are just astronomical. This was one of the good guys, an excellent, caring doctor. Many other OB/gyn's in this state have either changed speciality, gone into teaching or left the state. This affects all doctors, but some specialties more than other.

    And Mikie, about your experience at the supermarket...my daugther worked as a cashier when she was in high school. She told me at the time that she used to feel sorry for people with weight problems, but after seeing what some of them bought to eat week after week, she said that it was obvious that most people bring the problem on themselves (I know, and she knows, not EVERYONE does, but MOST do).

  7. elsa

    elsa New Member

    Very interesting post. Thank you for making the effort and taking the time creating it.

    Some food for thought .... Many are very distressed over the FFC and their greediness. I'd like to provide another angle for some to ponder.

    Remember .... I'm not a patient but I do know the healthcare and insurance industries.

    Managed Care was a very good idea. It has fallen way short. HMO's are not nearly as common place as earlier times. They angered people .... the average individual when given a choice will pick a PPO over an HMO. More choices, etc ....

    Someone forgot to put an effective oversight control mechanism in place when the business of managing all aspects of healthcare came into be.

    Insurance companies are at the center. Surrounding them are pharmacies, MD's, MD Groups, Diagnostic Testing facilities, Rehabilitation centers, Medical Equipment and Supply companies, NFP Hospitals, Nursing Industry, etc.

    Insurance companies in the center are in control of the show. They establish different "packages" or "bundles" of healthcare services. Usually sold to private businesses, government divisions, etc for their employees to "select" which bundle works best for them. Insurance says that this gives people

    O.K. - The insurance company goes to each and every surrounding healthcare component and negotiates fees for the different "bundles". Don't forget that each have to get something out of the deal. The diagnostic labs for example get guaranteed business.

    The Ins. Company goes all the way around the wheel until they have deals in place and bundles locked in.

    Once it's done, there is no wiggle room.

    The idea was a good one however no one is watching over the insurance company, making sure the "power" doesn't go to their heads, so to speak. They have taken a good idea on paper and have come close to ruining it.

    How? The insurance companies are like unsupervised teenagers. No parents in sight to make sure they don't step too far over the line .... or step over it at all.

    That much power and control is an enticing "red apple". Very difficult not to abuse.

    All the components signed a contract with the insurance company in the center. They didn't really have a choice but to sign if they wanted to stay in business. They have all been "playing along" for 10-12 years now. Long enough to form opinions on the entire concept.

    Back to the FFC and their "greediness". Many people are not aware of the number of specialized, independent healthcare providers out there that do not accept insurance. Many components of the wheel are over it. They have worked like dogs and not liking the outcome 10 years into this.

    Cancer Centers of America, Critical Cardiac Care, FFC, Wound Centers, Cosmetic Surgery Centers, etc. All of these "broke away" from the wheel. They, just like a high number of patients, got tired of being under the thumb of the boss in the center.

    And guess who else has had it? The diagnostic centers. I'm not speaking of the small, independent labs, but the two biggest boys on the block. Quest and Lab Corp of America.

    How are they breaking away? They are offering testing to the public that does not require a physician's signature. You are in control of knowledge.

    This is fee for service .... Meaning that if you by-pass the MD and order tests on your own, then it is a cash basis only. This is where many here are misinformed, believing that the diagnostic centers are charging harshly inflated prices to the poor unsuspecting sap who dared walk in off the street. This belief is easily corrected.

    Take a look at your explaination letter from your insurance company on the last blood work/lab they paid for. The charge or price of each individual test will show up, the % of discount ( agreed on in the contract they signed.Discount is actually what the insurance company said they would pay for a particular test. The word "discount" puts a prettier face on it.), and the actual amount of money the payor (insurance company) paid.

    You will probably be jaw dropping shocked at the price of the of each individual test. You'll be thanking God above you have insurance to cover it. Wow, how could we ever live without our MCO ?

    Next, take that same test and look up online what the lab would charge you for it if you walked in off the street and ordered it fee for service. You will not believe your eyes.

    The fee reflected in that insurance letter is hundreds of dollars more then the fee charged to the poor unsuspecting sap who walked in off the street. This is the reverse of what many are thinking .... these components are not ripping us off if paid by cash.

    The FFC and other specialty clinics are working just like the lab example I gave you. You pay cash for the doctor's time. My sister is a HRT - Anti Aging client of the FFC ...
    $165.00 for a professional consult is not ripping off, stealing or being out of control greedy. I do not understand how anyone could say otherwise.

    An MD has invested a huge amount of time, energy, resources and money to become an MD. It is right that they receive proper compensation.

    Ten years of education past high school deserves more compensation then high school completion only ... or 4 year college degree only. To say otherwise is incorrect.

    These specialty clinics, independent MD's or groups, for -profit private hospitals, diagnostic labs all break away from the wheel because they are tired of working like dogs for a substandard fee.

    The family physician took it up side the head more then any other group. They didn't have a choice at the time ...The healthcare climate then was strong enough that if they didnt sign up they would go out of business.

    Their yearly patient load grossly increased. Their daily patient load is between 60-70 patients per day way up from pre-MCO days. Their pay decreased 25% to 50%. Their hands became tied when trying to treat their patients. They no longer got a full vote on treatment protocols. There isn't a person in the world who would think this is a good deal.
    Unionized people who be screaming their heads off.

    The specialized clinics, MD groups etc, could not break away if there was not a large population demanding their services. It truly is patient driven. That is simply supply and demand. Prior to patient demand, the "break-away components" would have gone broke.

    The FFC as an example: In these fee for service clinics the client/patient is the one in control by virtue of their wallet. They have the money. They have ideas on what they want for that money. They can choose what they want and by-pass the rest.

    A doctor looks at my sister and says you need these vitamins, this IV and these bio-identical hormones. My sister says I'll take this one vitamin, I say no thank you to the IV's, and I'll have the prescriptions filled at my compounding pharmacy at home.

    Some of you would have us believe that the true scenario I just stated is not possible. You are trying to make us believe that we don't have control. That it is all or nothing with the FFC .... Their way or the highway. Rubbish. The patient is in control ..... BECAUSE THEY HAVE THE MONEY.

    Would you have us believe that a clinic who receives every penny of revenue from the client/patient only, would turn a patient away totally if the said patient refused to purchase the ENTIRE PACKAGE? They cannot afford to boot one out the door for refusing to spend the money on the entire package. That's revenue that is lost forever ... no means of replacing it. They will take what the can get and be happy to get it.

    I think many have forgotten how to be consumers in healthcare. You are the boss in fee for service. You are in control. You get what you pay for.

    In fee for service you are paying 100% vs paying a small co-pay with insurance paying for the bulk of cost. That "bulk" makes the insurance company the boss. Don't forget that the prices for fees are falsely inflated when insurance is the payor. Remember "the fee, the % of discount and the actual amount paid" mentioned above.

    When you buy a car the salesman is going to try and get you to buy an extended warranty, a service contract for the life of car, road side emergency assistance, and upgrades. They would love you to by all these things. If you opt out of buying them the car salesman is still going to sell you the car. He cannot afford not to. He will not boot you out of the dealership because you refused to buy the "entire package".

    This is no different then the FFC and people who are portraying otherwise are incorrect.

    In my world, I learned as much as I could about the major industries being discussed today. I did this so I could fully understand and make the best decisions for me.

    We pay an internist a certain amount per month. It is automatically deducted from our acct. It doesn't matter if we see him every month or not ... still pay the fee.

    This fee gives us two complete physicals, 24/7 access by phone or email with guarantee of return call within thirty minutes, no waiting for appointments, appointments that day or the very next day, as much time with doctor as needed ... no time limit on the appointment.

    He coordinates specalists appointments and goes with us if we want him to. He has a fixed number of patients ... none of this 1500 to 2500 patients per year. He coordinates all meds and pharmacy interaction.

    Guess what ......?!? It costs us less then the annual PPO premium set by the insurance company for general healthcare. We are saving money, receiving individual attention / customer satisfaction.

    Our insurance is aimed more at emergency, critical care and hospitalization. Our insurance dollars are being spent in a manner that benefits us the most.

    So you see, there are many things to think about and new ways to approach healthcare. There are more options. The doctors at the FFC didn't get greedy .... the patients got fed up with being treated like cattle in a box car that didn't get a vote on what happens to them. We the patients have more options.

    Companies are now offering new hires an interesting deal. Most feel like their insurance is free because their "company pays for it" ( or at least a vast % of it). It's not really free. The resources have to come from somewhere and that somewhere is your salery. If you want their MCO / HMO / PPO then you can sign up for it and receive a smaller salery. Your worth reads salery plus benefits.

    If you opt out of the company provided insurance benefit, you get paid more dollars ..... With those dollars you could then negotiate your own "deal" with a primary care group.

    Of course you would still need catastrophic, critical insurance coverage. I'd still get that from your employer.

    All foods for thought. Fee for service is not greed or a chance to rip you off. It is an environment where you are 100% in control. You are the boss. The docs like it because the feel they are getting a fair wage and are not be driven into the ground.

    The diagnostic labs see an oportunity to make money by selling a reasonably priced service direct to the public with less redtape. They don't have to inflate the prices to make money ... they are creating resources just by making the product available.

    And so forth ..... At the moment, insurance companies are beginning to sweat. Their little "wheel" is beginning to crumble. The components saw dissatisfied clients/patients and made products/services that matched up with what the clients/patients wanted. I suspect the insurance industry will adjust their current product list to a more patient friendly list in an attempt to hang on to the market share.

    Very long I know but something some may be interested in reading. You could look up Lab Corp of American right now and have your l-carnitine levels checked. We cfs/fms patients are routinely deficient in this yet not many doctors inside the current mco can order this test for fibro. patient. So .... a wheel component has made it so we can order it done ourselves. Pretty cool I think ...

    Take care,


  8. tansy

    tansy New Member

    I live in the UK. We have a nationally funded health care system that will only fund what NICE (National Institute of Clinical Evidence) say they can; it's called Evidence Based Medicine. The European Parliament (EU) has criticised NICE for the long delays in approving life saving Tx, the wheels sure do turn slow here.

    There are private health insurance policies for those who can afford them, though these can speed things up, very often the Tx offered are no different from what the the NHS provides. The insurance industry here has guidelines too, their guidelines on ME/CFS and FM are the same as those being followed by our policy makers. Wessely and his colleagues are paid by the insurance companies as advisers.

    Just as in the US some of the good and caring doctors have opted out of the system altogether, it's the only way they can give their patients the Tx they feel would make a real difference. Others divide their time between working for the NHS and seeing patients privately. This especially applies to doctors who practice integrative medicine.

    Consumers can influence policies though. We witnessed this in the UK when it was planned to follow the EU directives on supps etc. There was a concerted and organised grass roots campaign to ensure we retained our right of choice. We are not out of the woods yet, but it shows what can be achieved when the will is there.

    Unless everyone of us speaks out then the status quo will continue. I did not have the luxury of waiting for attitudes and Tx guidelines on these DDs to change here, I was going downhill again fast. Due to the problems many of us face here, I could not even access the same level of health care those without these DDs get.

    So I had a choice continue going downhill, or spend what little energy I did have researching. We can all help ourselves to some degree, even if it's just through diet etc. There's no guarantees but at least doing so increases our odds and makes it more likely that potentially helpful Tx will have a beneficial effect. All Tx for these DDs are experimental; accepting that is as important as being willing to take whatever aspects of our health care we can into our own hands.

  9. Mikie

    Mikie Moderator

    I think many are unaware of the complexities of the health care systems today and unaware that they cannot be passive patients. We cannot depend on docs; we absolutely have to do our own research and be knowledgeable about our illnesses and the treatments. Then, we have to decide how to get the testing and treatments we need.

    One thing I need to clear up is that I understand that there are those who have done everything possible to take responsibility and try to live healthy lives only to continue to get sicker. It makes me very sad that there are those for whom nothing seems to work. All I can offer are my prayers for healing.

    I've also been around healthcare and insurance for years. When my ex and I had little kids, he had a good job and almost everything we needed was covered in full. Those days are pretty much long gone. We are expected to pay ever increasing percentages in the forms of deductibles, co-pays, and co-insurance.

    I knew that getting the PCR DNA tests for the mycoplasma infections would never be covered by my HMO and my doc said as much. He had no incentive to fight for me to get them either. He said he goes home every night wondering whether he can stand another day. He dropped my insurance company and I have changed PCP's. He did listen to me and read all the info on mycoplasmas and was willing to try the Doxycycline empirically. He was only willing to do this because he had come to respect my ability to research. I learned how to get the treatment I needed without fighting with my insurance company nor expecting them to cover tests which would have been seen as rediculous to them. In a perfect world, the tests would be covered.

    My HMO/PPO now offers a really lousy version of the Medicare Rx plan. It helps me very little. To offset the cost for those who benefit from it, the HMO/PPO has increased the co-insurance for outpatient procedures from 5 percent of what they allow to 15 percent of what they allow. The stop loss is $3,800; that is the maximum out-of-pocket expense in one calendar year. Still, I pay no premium for this health care plan. If I were to buy disability supplemental insurance, it would cost more than $3,000 a year. I figure that the healthier I keep myself, the more money I save.

    This seems to be the best deal for me where I live. I can use out-of-network docs and the plan pays 80 percent of what they allow. Most of the docs here are in their plan, so it really isn't an issue. If I were to go to the FFC, I would have to drop this plan and go to straight Medicare to get the tests at Quest paid for. Then, I would have to get back into the HMO/PPO before the end of June. This means I would have to sign up by the May 15 deadline.

    I printed out the FFC test list and will take it to an endocrinologist when I make an appt. I'll see which tests he or she thinks I can get done. I've managed to get similar care to the FFC's on my own with what I've got, so unless I get worse, I think I'll wait to see what I'm going to do. Tansy has been remarkable in her ability to research and get treatment where there is really a hostile environment toward our illnesses. She continues to be an inspiration.

    BTW, yes, I did leave out the greedy attorneys and litigeous patients. How could I have overlooked them :)

    As I asked on the other thread, please let's keep the discussion civil so that we don't lose this. I think it's a very important discussion to have and the implications of the health care crisis will affect us all, regardless of where we live. Thanks for all your valuable input; I really appreciate it.

    Love, Mikie
  10. slowdreamer

    slowdreamer New Member

    Firstly sorry you're having a bad time Wake me up..I can only hope there is some improvement and you can find some peace..I can recognize your feelings...have had them at various stages.

    This post is reminding me of my T Shirt Quest which I was on about some time ago

    How about these slogans




  11. darude

    darude New Member

    Agree with you there is no need for name calling here!!! As for myself It was clear to me that the docs could not help me early on. One doctor even told me so. The meds I was given made me far worse and I went thru withdrawal on one which nearly finished me off. I decided to try and help myself and started supplements etc. Some have worked and some haven't but I am a lot better now. I went from bedridden to being able to walk an hour a day and do some chores around house. Unfortunately I went back to bad habits, smoking, eating sugar, coffee etc. and of course overdoing!!! WAS NOT listening to my body. Have started back on the supplements and am improving again. I have found out that I have other illness during the course of this and the doctors can help with some of this. Having been misdiagnosed twice in my life makes me nervous of the medical profession. When a teenager I had servere stomach pain for three years. I was told it was constipation. Then my appendix ruptured so surgery and long recovery time. In my 30's severe pains in chest was told it was an ulcer. Several years on Tagamet but was getting worse. Went to doc and he had substitute doc in. Doc asked why was I taking tagamet!!!!!!!!!!!!! I had scam of chest a year before and it showed Gallstones. One was pushing thru and I immediately had surgery. Also when I had an MRI last year they put that a mass might be an aneurysm and I should be called immediately. No-one called!! I went to get copies a few weeks later and found this out. Luckily it wasn't one. I also have to say that all this was in different countries and different docs.
    [This Message was Edited on 01/08/2006]
  12. oholland

    oholland New Member

    So everyone says the FCC clinics are good and their tests tell you so much about these DDs and "how wonderful" they use Quest Labs which my insurance approves.

    "But, oh no," says my insurance company, "we won't pay if you have tests done at Quest for the doctor at the FCC clinic. We do not approve of anything the FCC does."

    "But wait! If I get a copy of the list of tests and take it to a doctor on your "approved" list will you pay then?"

    "Why yes!" says my insurance company. "100%!"

    So we are put in the position of playing games to try to advance the condition of our failing health. And we get the list of tests and supplements the FCC suggests and we take them to our doc and together we develop a PLAN that is paid for by the insurance company and we search the internet for the supplements and get the compounding presciptions at a reduced rate. Gosh this is fun!

    The good part? I feel better and my doc has learned a lot and is helping other patients too!

    I usually never blame doctors. Your ordinary general practice or family doctor is not getting rich in todays climate of insurance and medicare controlled fees while paying the astronomical prices of malpractice insurance, increasing rent, labratory and staff costs. The only way a doctor can increase his salary these days is to get out from under the insurance and medicare/medicaid umbrella and go into a specialty practice that is free from malpractice worries. My brother-in-law has assisted more and more physican's with the filing of Chapter 11 in the last few years and it is continually increasing.

    However, the insurance companies and pharmaceuticals are another story. They have the government by the short hairs and their hold increases daily! Yet who has a solution?

    And how much are we to blame for our health? We know that eating sugar, drinking sodas, and our steady diet of fast food only adds to our declining health but how many of us have stopped cold turkey?

    How many of us with the pain of FMS do our gentle exercising daily, even if its in our beds? We know that if we don't we are simply making our condition worse and yet our pain is so great that even stretching seems to be too much.

    However, since I first started stretching in bed every morning, slowly warming up my limps and then finally over the months progressed to just bouncing on my rebounder and then started walking more with a cane, I now find that I can walk on my own. I drive, shop for groceries on my own, and even do some light housework. All this when I was almose bed bound a year ago.

    But that's me. Just me. I cannot expect others to do less or more.

    Can I blame the man in line for eatting the cookies while he is obsese when I don't know his problems? Does he have cancer and is on steroids which is causing horrible hunger pains and weight gain while he waits for brain surgery? That's what my brother-in-law is going through at this moment. He has gained 45 pounds in the last month from the steriods and can practically gnaw the paint off the door he is so hungry all the time. His brain surgery is next Tuesday and if bags of cookies will keep him sane until then...then let him eat cookies.

    There is plenty of blame to go around for sure, but we all have to remember not to dish it out too freely!


  13. petsrme

    petsrme Member

    A few weeks ago posts much less argumentative and attacking were deleted very quickly. Why is this verbal attack allowed to stay? It is very distressing and sad. This is supposed to be our safe haven where we don't have to feel judged or hear the things we hear from those who don't understand in our everyday life. I thought everyone here understood and knew that we can't will ourselves to be better or do more. I thought it was okay to support each other and give each other a pat on the back when we are down and a high five when we are doing good.

    I wish life was that easy that we could will ourselves to do more and improve. Trust me, I would never be in a wheelchair just because I thought I needed to be. I would have to be in one because I HAD to. No amount of positive thoughts or reality checks could make me stand up or get out of a wheelchair. If I ever have to use one it will because I have no choice. Thank goodness I don't have to use one. I just use this as an example. It is great to never give up and do all that you can, but it doesn't mean you can always do more if you will yourself to.
  14. LADYBUG2

    LADYBUG2 New Member

  15. Mikie

    Mikie Moderator

    Janice, if you read the entire post, you will have read that I said I wasn't judging this man as I don't know his circumstances. I was using him as an example of someone indulging in extremely harmful behavior for his health. I am sure that a lot of people are depressed, but our nation is in a crisis of obesity and Type II Diabetes. Both of these are usually preventable. It isn't easy, especially for us who can no longer do aerobic activities but I think we have to try.

    "Blame" may be an inflammatory term. Perhaps I should have asked, "Who Is Responsible." When one gets right down to it, we are responsible for those things which we can control. That's all we can do.

    Petal, I don't mind telling you what insurance I have at all. I am on disability Medicare. The only supplement for people with disability Medicare here is through United American. It is an excellent company with probably the best supplement on the market. It just costs so much where I live that I can't afford it.

    I have the United HealthCare Medicare Complete HMO. It is called an HMO but if one wants to use it ouside the network, in our geographic area, it pays like a PPO. The eye doc I see is willing to bill them even though he isn't in the network and I often end up paying less than a co-pay on the HMO. These Medicare HMO's can have different benefits from county to county in the same state. Also, they may not be available in every county.

    Humana has come back into our area (they left 5 years ago) and several new plans are now available. The reason I stay with UHC is because I don't have a gatekeeper PCP; I can make appts. with specialists on my own. What I don't like is when I do need preauthorization; they can be slow.

    I don't know which would be easier, to work sick to get regular Medicare or to wait the 29 months it takes, from the date of disability, to get Medicare. It's 24 months from the date one is eligible for benefits which is 5 months after the date of disability. I think the only one who can make this decision is the one involved. Unless one has insurance through a spouse, it would cost a fortune for insurance for those 29 months and it may not be available due to pre-existing conditions. An insurance broker could provide the options.

    Olivia, I don't blame family docs either. They are typically not the ones whose greed brought managed care into being. It's the specialists who were performing unnecessary expensive procedures. My Dad was a family practitioner all his life and he didn't get rich from it, even before managed care.

    As I mentioned to Janice, I was not blaming the man at the grocery store but rather observing probably the worst example I have ever seen of poor health behavior. I'm sure one could imagine this man is also in pain and needs his cigarettes to help with his pain so let him smoke and let him have his cookies. I'm not judging; I'm just observing. Again, perhaps had I used the word, responsibility, it would not have upset people.

    Thing is that our children are getting more and more sedintary, less fit, and more obese, generally speaking. Just watch the news or, better yet, look around, not to blame or judge but to observe. People who are sick due to lifestyle choices are putting a huge drain on our health care resources.

    Some employers will no longer hire smokers and those who smoke will have to quit or lose their jobs. The employers are offering exercise areas at work or health club memberships. Empolyers' insurance premiums are going out of sight and if they don't do something, they will no longer be able to offer insurance to their employees. While this is controversial and many will be outraged at it, it's the new reality.

    Health care crisis is not too strong a term. The results affect us all whether through increased treatment costs, insurance premiums, or taxes for programs like Medicare and Medicaid.

    My point in posting this is to show that there is ample blame/responsibility to go around. It isn't just the docs or the insurance companies. It is just too simplistic to blame one cog in this broken mess we have now.

    Love, Mikie

  16. darude

    darude New Member

    I totally agree!!!! Let support each other!
    hugs Annie the Londoner!
  17. elsa

    elsa New Member

    We seem to have gone in another direction. I hate when people's feelings get hurt however I wish this very informative thread had stayed on topic.

    Alot can be learned from Tansy's experience in the UK. What did ya'll think about the new direction docs are going in .... away from managed care? I wish ya'll had added to this more.

    What do you think of healthcare, personal responsiblity, fee for service specialty clinics, insurance company's huge involvement in the healthcare process, etc?

    These things I would be very, very interested in hearing about.

    Take care,

  18. elsa

    elsa New Member

    Faye, it sounds like you are doing well ... in a relative manner.

    Pushing beyond what you can do is the opposite of what one should do when dealing with CFS.

    Truly, if your body says "bed rest" it means it. I think it was Chaney who first highlighted the dangers to we CFS patients who were being strongly suggested by our doctors to get moving.

    With all you are doing on a day in day out basis I think you are doing well .... not where you want to be, but not in the stage of body demanding round the clock bedrest.

    I call them stop days. I haven't needed to take one for a while. It used to be I would have on a regular basis in order to recover from certain activities.

    I'm glad you have good insurance coverage through your husband. That takes alot of stress off of us. I do like very much fee for service MD's and specialty clinincs as it has afforded me a large amount of control over my care.

    It goes beyond CFS/FMS, back to when I was very ill in '98 with something else. My insurance company (which has a great reputation) refused the treatment my doctor wanted for me. Said it was approved for kidney disease and not for anything else.

    My specialist at the time in a very loud, agressive voice said @$#%@ I'll pay for it. This is going to save her life.
    If it doesn't then you won't be out of anything. If it does you'll have to reimburse me and live with yourselves.

    As it happens, obviously, it turned out my doctor was right. The treatment now is typical for the condition. Thank God for that doctor.

    Couple that with the general hesitation in treating CFS/FMS, I much rather go to a fee for service MD. In actuality it costs us less.

    We would never turn away from emergency, critical care, acute ins. coverage but for the day to day healthcare I really don't want the insurance company getting a vote.

    Thanks for responding. I hope you are doing well.

  19. tansy

    tansy New Member

    due to lack of funds and the NHS being overwhelmed by the demands being made of it.

    Hospital and primary care trust have always used certain tactics to cut down on their expenditure, these fall in line with the change in emphasis here to prevention rather than having the population rely upon the NHS to fix potentially preventable health problems.

    Recent financial crises have led to more patients being refused surgery etc because they are obese, won't exercise, smoke, or drink too much. Patients are expected, or encouraged, to adopt a healthier life style. My last GP appt may have been a total farce but he checked my BP (normal this time :)), weight, diet, exercise levels; he also asked if I smoked or drank alcohol.

    What is being written about is happening in many other countries too. The rising costs of health care, due in part to the influences of the pharmaceutical industry, have added to increased demands for what patients hope medicine has to offer them, this has inevitably led to the difficulties we see now. Many countries and insurance companies cannot meet these increased demands so some are opting for one of two options: refuse Tx and/or expect the patient to take some of the responsibility for their own health.

    No one knows better than I how difficult it can be to get anything investigated properly or treated if we have these Dxes; or how financially challenging it can be to have to resort to self funding when we have a very modest income. Living in the UK I am realistic about my odds of getting any worthwhile funded TX directly related to my ME/CFS and chronic infections. All I can be offered is CBT or graded aerobic exercise programmes most of which are based on the false illness beliefs hypotheses.

    Elsa and Mike were right to keep bringing this topic back to it's original purpose. Health care has changed over the years; it's as difficult for the decent and genuinely caring health professionals as it is for the patients.

    No matter how ill we are, or how severely affected we are, we can help ourselves to a certain degree. It's not easy or straightforward I know, but then neither are these DDs.

  20. darude

    darude New Member

    Back on track.

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